EWWWW, something doesn't seem right to me here!!

NurseyPoo, RN · Mar 22, 2007

Something is very wrong with that!!! There are many-many things that can be passed through saliva, and not to mention sometimes Intubation can be very aggressive, and this equals BLOOD!!! Is someone misunderstanding the items to be sterilzed?

b eyes · Mar 22, 2007

Something is very wrong with that!!! There are many-many things that can be passed through saliva, and not to mention sometimes Intubation can be very aggressive, and this equals BLOOD!!! Is someone misunderstanding the items to be sterilzed?

I would like to say they did not understand, however, they came to the ER and showed me how they would like me to do it!! I was absolutely mortified!!

meownsmile, BSN, RN · Mar 22, 2007

Well,, it doesnt sound to far off to me. First, does your local restaurant actually "sterilize" your drinking glasses? No they do run them through a hot dishwasher maybe, but a lot of restaurants dont, dishes are washed by hand with sprayers. As many homes as do, dont have dishwashers that have the capacity to "sterilize" dishes, does that mean that if little johnny down the street comes in and has busted his lip, you wouldnt let him drink out of one of your cups because he was bleeding? No you'd take care of him and let him rinse his mouth out, and help him. Since the blades you are talking about dont enter the respiratory system and even if they did they would drag cocci down the trach with it, from the mouth, I would think a good clean environment is as acceptable as using a "sterile" blade.

The last thing they are worried about when intubating a patient is infection, that can be delt with later. Those blades arent sterile anymore once they hit the patients tongue anyway.

b eyes · Mar 22, 2007

Well,, it doesnt sound to far off to me. First, does your local restaurant actually "sterilize" your drinking glasses? No they do run them through a hot dishwasher maybe, but a lot of restaurants dont, dishes are washed by hand with sprayers. As many homes as do, dont have dishwashers that have the capacity to "sterilize" dishes, does that mean that if little johnny down the street comes in and has busted his lip, you wouldnt let him drink out of one of your cups because he was bleeding? No you'd take care of him and let him rinse his mouth out, and help him. Since the blades you are talking about dont enter the respiratory system and even if they did they would drag cocci down the trach with it, from the mouth, I would think a good clean environment is as acceptable as using a "sterile" blade.
The last thing they are worried about when intubating a patient is infection, that can be delt with later. Those blades arent sterile anymore once they hit the patients tongue anyway.

I still disagree. As I said, then it would be the same as using the same yankauer for each patient just wash with soap and water between uses. This day and age, just doesn't seem like safe practice to me.

meownsmile, BSN, RN · Mar 22, 2007

However, friction can be applied to the inner and outer aspect of the blades,, where with something like a yankar,, you dont have the ability to apply friction to the inside of the tube during the wash process.

Maybe talk to your infection control department and see what their rational is in not sterilizing. Have you checked another cart, or notice next time if the ones in the new cart are packaged by central sterile. If they are packaged then someone must not be clear up in the sterile department.

jrring1019 · Mar 22, 2007

Dental instruments are sterilized, would you go to a dentist that just washed them with soap and water? Yuck. I don't care that it is no longer sterile after it touches MY mouth, I just don't want anything left over from the last patient!

Also, everyone has a different standard when it comes to cleaning, right? One nurse may scrub and scrub until it is almost sterile, while another may just wipe it down.

Altra, BSN, RN · Mar 22, 2007

In the 3 different ERs where I have either worked or had clinical experience as a student, the blades & handles were stored in the "Airway Bag" or the "Airway Cart" -- they are NOT sterile-packed. Infection control nurses help me out -- is there any point to sterilizing something which will remain open to air, which is not sterile?

Having said that, ours are cleaned in a solution which definitely has better anti-microbial properties than soap & water.

widi96 · Mar 22, 2007

In our ER CS does sterilize them, but when they come up we open them and put them in our airway bag / cart. Intubation is not a sterile procedure, but it is nice to know that the equipment is at least free of bugs from the last patient it was used on. Sterile: No. Clean: Yes.

Lurksalot, BSN, RN · Mar 22, 2007

Interesting discussion--in our RSI bags and crash carts we have blades lying in the drawers open to air and also other blades in sealed sterile plastic. How's that for a conundrum??!! :rolleyes:

Had to edit to say it brings up some good points...I was wondering the other day along these same issues about using alcohol preps to cleanse ports before accessing IVs, and the new nurse in me wants to stick to always wiping ports because it is the right thing to do for the patient....however, I see in codes it does not always happen, yet I can't say it really matters during that sort of situation---I mean, if someone is getting intubated because they are dying then not wiping a port is the least of their problem.

Do I always wipe ports? Yes, that is how I practice, and I always have wipes in my pocket. Do I think the blades should be sterile? No, I do not think they need to be sterile, but they should be clean---more than soap and water clean.

Good discussion, I am looking forward to all the replies. Sometimes it is tough to reconcile reality with practice.

b eyes · Mar 22, 2007

In the 3 different ERs where I have either worked or had clinical experience as a student, the blades & handles were stored in the "Airway Bag" or the "Airway Cart" -- they are NOT sterile-packed. Infection control nurses help me out -- is there any point to sterilizing something which will remain open to air, which is not sterile?
Having said that, ours are cleaned in a solution which definitely has better anti-microbial properties than soap & water.

What is the solution that you use to clean your supplies? I know they are not packaged sterile, however, I think that they need to be cleaned much better that soap and water. Something else to kill the germs that the scrubbing doesn't do and in our facility things that need that go to central sterile. Just think about the concept. some intense heat would be a good idea, and whatever else they do. I am not sure of. I know if it was my loved one who survived an intubation, I would not want them to have to deal with any other blood borne pathogen that is out there.

Altra, BSN, RN · Mar 22, 2007

I'll find out what the solution is and let you know.

I do know that the fiber optics in the blades present an issue, i.e., we don't drop them into the same "green stuff" that other used instruments go into.