Chapter 1and 2 presentation

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1.Emerging Evidence inInfection Control EffectingChangeMelissa D. Machan, ARNP,CRNA2. BackgroundNosocomial infections cost hospitals agreat deal of money every year and affecta large amount of patients admitted to thehospital.Nosocomial infections could potentiallyresult from visible and occult bloodpresent on reusable anesthetic airwayequipment.It has been established that the currentmethods for sterilizing and storingreusable laryngoscope blades areineffective. 3. Background ContinuedIntubation of the trachea has been a riskycross-contamination procedure over the pastcouple of decades because no perfectdecontamination procedure exists.Disposable laryngoscope blades have beenmade available to prevent potential crosscontamination while intubation of the trachea isbeing performed.These single use disposable laryngoscopeblades have come with mixed reviews fromanesthesia providers. 4. Purpose of the ProjectThe purpose of this evidence based project is todetermine the perceptions of anesthesiaproviders regarding the use of a disposablelaryngoscope blade, their frequency of use, theirevaluation of ease of use, and any complicationsencountered when using the disposable bladebefore and after an in-service program designedto increase use of disposable blades. 5. PICO QuestionIn patients requiring intubation (P), how does theuse of a disposable laryngoscope blade (I)compared with a reusable laryngoscope blade(C) affect ease of use, complications, and cost(O)? 6. Research QuestionsWhat is the perception of anesthesia providersregarding ease of use, complications, and costof disposable laryngoscope blades before andafter the in-service program?What percent of anesthesia providers usedisposable laryngoscope blades before andafter the in-service program?How many disposable laryngoscope bladeswere used in the facility in the 3-months beforeand after the in-service program? 7. Research QuestionsWhat is the anesthesia providers evaluation ofease of use of the disposable laryngoscopeblade?What are the providers rationales for non-useof a disposable laryngoscope blade after the in-service-program?What complications did anesthesia providersencounter when using a disposablelaryngoscope blade? 8. Studies Investigating the Presence of Visible and OccultBlood on LaryngoscopeBlades and HandlesAuthor/DateDesignSampleOutcome InterventionsResults LimitationsWilliams et al. Randomized192 specimensAssessed forLaryngoscopeOne or more Inadequate(2010)blinded Study from 64bacterial handles.species ofsensitivity oflaryngoscope contamination bacteriathehandlesand occultwere isolated detection ofdeemed readyblood.from 55(86%)blood methodsfor patient use of the handles. employed.in the No occult Sites B and Canesthetic blood were swabbedroomscontamination for microbialof 32was contaminationoperatingdemonstrated. prior totheatres.sampling for occult blood. 9. Studies Investigating the Presence of Visible and OccultBlood on LaryngoscopeBlades and HandlesAuthor/DateDesignSample Outcome InterventionsResultsLimitationsPhillips &Prospective Sixty-fivePresence of Visible and None of theContaminationMonaghanobservational laryngoscope occult blood occult bloodblades orcould have(1997)study blades andonhandleshappened afterhandles laryngoscopeobserved had theidentified as blades andvisible blood. sterilizationready for handles thatOf the 65patient use wereblades testedwere observed identified as for occultfor visible ready for blood, 10blood and patient use (20%) testedtested forpositive. Ofoccult bloodthe 65 handlestested foroccult blood,26 (40%)tested positive. 10. Studies Investigating thePresence of Visible and Occult Blood on LaryngoscopeAuthor/DateBlades and HandlesEsler et al.Design QuestionnaireSample Of the 289OutcomeCleaningInterventionsSurveyResults One third ofLimitations Conducted(1999) questionnaires methods methods of the units the outside the sent out, 239laryngoscope handle is not United States were returned. cleaning incleaned at all.units throughOnly 5%Great Britain. routinely autoclave the handle and in 12% of the units, disposable laryngoscopes are used. One third would not be prepared to put a cleaned blade into their mouth. 11. Studies Investigating the Ease of Use of Disposable Laryngoscope BladesAuthor/DateDesignSample Outcome InterventionsResultsLimitationsAnderson et Randomized32 anesthetists Ease of use StandardEasy Although aal. (2006)unblindedstud with betweenreusablesetting: high-fidelityy 11 months and laryngoscopelaryngoscopy patient25 years of bladesmore difficult simulatorexperiencewith the allows forusing a high- Standardcovered bladestandardized,fidelityreusable( p= 0.001)reproduciblesimulator laryngoscopeand theintubatingblades with disposable conditionsdisposableblades.there is debateblade coversDifficultas to whethersetting: it is anDisposablelaryngoscopy adequatelylaryngoscopemore difficult validated toolbladeswith both thefor assessmentcoveredof anesthetists.blades (22%,p=0.008)andthe disposableblades (69%,p