What's the point?

Decontamination of medical equipment, the combination of cleaning, disinfecting and/or sterilisation is used to render a reusable item safe for further use. The alternative is single use followed by disposal. There is currently much variation in decontamination practice for laryngoscopes and the majority of hospitals do not have local guidelines [1]. General guidelines for the decontamination of medical equipment are available [2] but, as Ballin and McCluskey have pointed out, these do not specifically refer to laryngoscopes [3]. The Editor of this Journal has announced that the Association of Anaesthetists has formed a group to advise on appropriate decontamination procedures for laryngoscopes [3]. While we welcome this move, we write to warn that times are changing and that new guidance is urgently needed, not only in relation to laryngoscopes, but for all reusable airway equipment. We now face the presently unquantified risk of our equipment transmitting variant Creutzfeldt±Jakob disease (vCJD). The transmissible agent, an altered form of prion protein, has been isolated from tonsillar and lymphoreticular tissue of human victims [4]. It has also been found in the appendix removed from a patient who subsequently developed the disease [5]. The prion protein is remarkably resistant to common techniques of decontamination, with complete removal considered very difficult [6]. The Department of Health has recently announced that they will follow the advice of the Spongiform Encephalopathy Advisory Committee and introduce single-use instruments for tonsil surgery [7]. Tonsillectomy is currently one of the most frequently performed surgical procedures in the United Kingdom, amounting to about 20% of all ENT operations [8] and this announcement may have major implications for anaesthetic practice. The mainstay of our practice involves airway control, currently using reusable equipment such as laryngoscopes and laryngeal mask airways. Soiling of this equipment with blood is common during ENT procedures such as tonsillectomy. It has been suggested that laryngoscopes used on patients with suspected vCJD are destroyed [1]. In light of the recommendation of single-use surgical equipment for tonsil surgery, we believe that there is an urgent need for national guidance on best practice regarding the decontamination of all airway equipment and advice on the need for singleuse, disposable equipment.