Contaminated surgical instruments and variant Creutzfeldt-Jakob disease

Airway management evolution - in a search for an ideal extraglottic airway device

Extraglottic airway devices (EADs) are commonly used equipment for airway maintenance during elective procedures under general anaesthesia. They may be used also in other indications such as conduit for tracheal intubation or rescue airway device in prehospital medicine. Current classifications of the EADs lack systematic approach and therefore classification according to the sealing sites and sealing mechanisms is suggested in this review article. Modern EADs are disposable, latex-free devices made of plastic materials most commonly from polyvinylchloride (PVC). The bowl of uncuffed sealers is manufactured from different materials such as thermoplastic elastomers or ethylene-vinyl-acetate co-polymer. EADs create various physical forces exerted on the adjacent tissues which may contribute to different sealing characteristic of particular device or to variable incidence of postoperative complications. Desired features of an ideal EAD involve easy insertion, high insertion success rate even by inexperienced users, protection against aspiration of gastric contents and low incidence of postoperative complications such as sore throat, hoarseness, cough or swallowing difficulties.

The cleaning of photographic retractors; a survey, clinical and laboratory study

OBJECTIVES

To determine the methods currently being used to decontaminate photographic retractors in specialist orthodontic practice and to investigate the effectiveness of the cleaning methods.

DESIGN

The study was carried out in two parts: I - a postal self-report questionnaire, and II - a cross-sectional clinical and laboratory investigation.

SETTING

The Orthodontic Department of the Charles Clifford Dental Hospital.

SUBJECTS AND MATERIALS

I - The questionnaire was sent to 278 specialist UK orthodontists. II - One hundred and twenty pairs of photographic retractors were collected following use. One retractor from each pair was randomly chosen to be the unwashed control and immediately placed in 20 ml of PBS-Tween for elution. The other was subjected to the one of four cleaning procedures: alcohol wipe, handwashing, ultrasonic bath or washer-disinfector, before being placed in PBS-Tween. Aliquots were taken for assay.

MAIN OUTCOME MEASURES

Antibody capture (ELISA) for amylase, to detect the presence of saliva, and for albumin, to detect the presence of serum.

RESULTS

I - The questionnaire response rate was 65% and the majority of respondents (87.2%) were routinely taking clinical photographs. A wide variety of techniques were being used to decontaminate photographic retractors. II - All unwashed controls had detectable levels of amylase and albumin. All the retractors that were cleaned using an alcohol wipe had residual detectable levels of amylase and 80% had detectable levels of albumin. Only one retractor had detectable amylase and one had detectable albumin following cleaning using the washer-disinfector. There was a highly significant statistical difference between the techniques in the proportional reduction in both amylase and albumin detected from the unwashed control and cleaned experimental retractors (p <0.001). The infective risk from inadequate cleaning of photographic retractors is discussed.

CONCLUSIONS

The washer-disinfector is the most effective method of cleaning photographic retractors, but no method was found to be 100% successful at removing amylase and albumin.

The use of single-use devices in anaesthesia: balancing the risks to patient safety

Single-use devices are designed, manufactured and sold to be used once and then discarded. This paper addresses growing concerns about the quality of some devices. Single-use devices, manufactured at a lower cost to justify their disposal, are perceived to have a lesser efficacy, which may threaten patient safety through iatrogenic harm. There is, in addition, growing scepticism about the actual risk of contracting variant Creutzfeldt-Jakob disease and other blood-borne diseases from reused surgical instruments. Interview data suggests that when choosing to use a single-use device, clinicians balance concerns about the risk of infection against those about the risk of injury. However, despite reservations about induced harm and the unknown risk of an iatrogenic disease, most clinicians would want single-use devices used on themselves and their family if they were patients.

A comparison of 20 laryngoscope blades using an intubating manikin: visual analogue scores and forces exerted during laryngoscopy

Fifty anaesthetists were recruited to use 20 different laryngoscope blades (one metal re-usable blade, five metal single-use blades and 14 plastic single-use blades, of which eight were bulb-type and 12 were fibreoptic-type) in a manikin to achieve a grade I Cormack and Lehane view. The anaesthetists were asked to provide visual analogue scores (VAS) for: ease of attachment of the blade to the handle; illumination; view of the larynx; and satisfaction for clinical use. The peak force applied and time to achieve the grade I Cormack and Lehane view were also measured. A cluster analysis method was used to group together blades with similar scores or measures. Ease of attachment, illumination, view, clinical use, force and duration were all significantly affected by the blade used (p < 0.0001 for all six). The mean peak force applied and mean duration for the 20 blades were 32-39 N and 4.4-9.5 s, respectively. All five metal single-use and four plastic single-use blades were always placed in the 'best' group in the cluster analysis. Two plastic blades provided a poor view and increased the duration of laryngoscopy.

The Portex 'Soft Seal' single use laryngeal mask -- a preliminary study in pediatric anesthesia

BACKGROUND

Portex have developed a single use pediatric laryngeal mask (LM), which is available in all sizes.

METHODS

We prospectively evaluated its use in 40 infants and children undergoing a variety of surgical procedures.

RESULTS

The LM provided a satisfactory airway in all patients. Insertion was quick and easy and achieved at the first attempt in 38 patients. Repositioning was required during anesthesia in four cases.

CONCLUSIONS

The Portex 'Soft Seal' LM performs satisfactorily in elective pediatric anesthesia.

Autoclave use in dental practice in the Republic of Ireland

AIMS

To assess by postal questionnaire, cross-infection control methods, especially sterilisation procedures, of 700 general dental practitioners in the Republic of Ireland, and to biologically monitor steam pressure sterilisers or autoclaves in their practices.

MAIN OUTCOME MEASURES

Methods of instrument cleaning and sterilisation, autoclave efficacy.

RESULTS

A response rate of 40% with all, except one practitioner, using steam sterilisation. 49% also reported the use of chemical sterilisation with a quarter of these using glutaraldehyde. However, instrument soaking time varied greatly from 2.5 minutes to 74 hours. Methods of instrument cleaning prior to autoclaving were as follows: scrubbing by hand 41.5%, ultrasonic cleaning 7.0%, combination of both 50%. 52.9% of the respondents did not autoclave their dental handpieces and only 44.7% disinfected impressions before sending them to the laboratory. The autoclaves of thirty practitioners (11.3%) did not pass the initial biological test. Following counselling about possible causes of failure, four autoclaves (1.5%) failed a repeat biological test. However, seven practitioners did not return the repeat biological test.

CONCLUSIONS

Some aspects of recommended cross-infection control procedures are well adhered to, e.g. instrument cleaning, but further education is required in certain key areas, in particular the use of chemical sterilisation, dental handpiece autoclaving and impression disinfection. There is also a need to increase awareness of the importance of routine autoclave servicing and calibration, along with validation and monitoring.

Cross infection control measures and the treatment of patients at risk of Creutzfeldt Jakob disease in UK general dental practice

AIMS

To determine the suitability of key infection control measures currently employed in UK dental practice for delivery of dental care to patients at risk of prion diseases.

MATERIALS AND METHODS

SUBJECTS

Five hundred dental surgeons currently registered with the General Dental Council of the UK.

DATA COLLECTION

Structured postal questionnaire.

ANALYSIS

Frequencies, cross-tabulations and chi-squared analysis.

RESULTS

The valid response rate to the questionnaire was 69%. 33% of practices had no policy on general disinfection and sterilisation procedures. Only 10 of the 327 responding practices (3%) possessed a vacuum autoclave. 49% of dentists reported using the BDA medical history form but less than 25% asked the specific questions recommended by the BDA to identify patients at risk of iatrogenic or familial CJD. However, 63% of practitioners would refer such patients, if identified, to a secondary care facility. Of the 107 practitioners who were prepared to provide dental treatment, 75 (70%) would do so using routine infection control procedures.

CONCLUSIONS

Most of the dental practices surveyed were not actively seeking to identify patients at risk of prion diseases. In many cases, recommended procedures for providing safe dental care for such patients were not in place.