An investigation into ambulance laryngoscopes as a potential source of infection amongst emergency medical service personnel in a private ambulance service in the eThekwini Municipality of KwaZulu-Natal

Abstract

Background Emergency care practitioners (ECPs) provide specialised treatment and management to a great number of critically ill and injured patients in the pre-hospital setting. Overall, these patients have the potential to have a higher incidence of infectious and emerging diseases. Part of patient management is securing the patient’s airway through the placement of an ETT into the trachea. This process involves the use of a laryngoscope which is an invasive tool that comes into contact with blood and other biological agents and can provide a medium of transportation of infections if not decontaminated adequately. Disinfection and infection control is a fundamental practice in emergency medical care (EMC) that is often underrated. To date, there is no consistency and an overall lack of consensus with regards to a formalised infection control policy with specific reference to decontamination practices of the laryngoscope in the pre-hospital emergency medical care sector in KwaZulu-Natal. There are limited published research studies investigating ambulances decontamination practices regarding laryngoscope blades and handles. Purpose: This study aimed to investigate the microbial composition of ready-to-use ambulance laryngoscopes, determine the common decontamination practices, and establish the minimum concentration of disinfectants required to clean this pre-hospital equipment. Methodology: This experimental study used a descriptive design, as the purpose was to identify and quantify the microorganisms isolated from samples of laryngoscope blades and handles, and determine the most efficient disinfection agents required to render these microorganisms harmless using minimum inhibitory concentration (MIC) assay. A questionnaire was used to assess EMS personnel's decontamination practices regarding the disinfection of the equipment. The study was be conducted in a private EMS sector setting in KwaZulu-Natal province area. This service is a 24-hour private EMS, with 27 emergency care practitioners who uses laryngoscope blades and handles to help in AM. vi Results: The results presented in this study showed clearly that there was a high bacterial load found on the ambulance laryngoscope blades and handles under study. This was evident in the colony enumeration as well as the gram stain processes. Furthermore, there was a high level of potentially pathogenic species, namely, Salmonella, Shigella and Pseudomonas sp., which is of great concern. This is an indication of substandard hygiene practices IPC practices. It is evident from the results and the interpretation above that the IPC knowledge and practices regarding laryngoscope blades and handles in the selected EMS in the eThekwini District of KwaZulu-Natal is poor. Conclusion Ambulance laryngoscope blades and handles have been found to have an unsatisfactory level of pathogenic micro-organism contamination, and may be a reservoir in the transmission of potentially serious infections to patients and ambulance staff. This underlines the urgent need for the development and implementation of evidence-based ambulance IC guidelines pertaining to the airway tool. These findings should be taken into consideration and used to urgently address the problem of ambulance laryngoscope blades and handles decontamination and infection control.