INFECTION PREVENTION AND CONTROL INSTRUMENTS FOR TRACHEAL INTUBATION

STATEMENT ON STANDARD PRACTICE FOR INFECTION PREVENTION AND CONTROL INSTRUMENTS FOR TRACHEAL INTUBATION 

Committee of Origin: Committee on Quality Management and Departmental Administration (QMDA(Approved by the ASA House of Delegates on October 20, 2010, and last amended 

on October 28, 2015) 

Statement: All instruments used for intubation of the trachea (endotracheal tubes, laryngeal mask airways (LMAs), laryngoscopes, fiberoptic devices, stylets, forceps, or other airway devices) should be properly cleaned using standard methods for decontamination and high-level disinfection between each patient use and stored in a clean environment. Sterility is not required. Prepackaged endotracheal tubes can be opened, cuffs checked for any leaks, stylets placed for future use, cuff syringes attached, and placed back into the package. Data suggest that storage and subsequent use of such prepared endotracheal tubes is reasonable for up to 48 hours.

 Rationale: The mouth (where such instruments pass on their way to the trachea) is not a sterile environment. However, cleanliness and prevention of contamination from patient to patient is essential and consistent with patient safety.

A focused review of the ASA Closed Claim Database (10,000 cases over 30 years) shows that there were no cases of infection from placement of an endotracheal tube or LMA. Neither were there any claims of infections from dirty instruments for tracheal intubation in this database.