laryngoscope blade and handle have been reported to harbor micro - organisms and occult blood making them a potential source of hospital - acquired infection ( hai ) . while , infection control in anesthesia is an issue of concern , the role of the laryngoscope in the spread of infection is often not well appreciated by practicing anesthesiologists . review of the literature reveals that though various attempts have been made to disinfect the laryngoscope , the reprocessing practices are seen to vary significantly from one healthcare facility to another . the guidelines which exist are incomplete , inconsistent , and inadequate , and there is a lack of consensus . india is a vast country with variable , nonuniform healthcare practices , and there are no well - defined guidelines available till date on techniques of laryngoscope decontamination . the present survey aims to determine common practices used for laryngoscope decontamination by our anesthesiologists . an online survey using google forms was conducted in 45 institutions to determine the prevailing practice of laryngoscope decontamination in their hospitals . the survey was sent to 100 anesthesiologists from 37 leading tertiary care centers of the country . the anesthesiologists were selected equally from each hospital so that there is uniformity in reporting . a questionnaire of 14 questions was prepared based on reported practices of decontamination and previous studies on the subject . the questionnaire was initially sent to five anesthesiologists who were not involved in the survey . after taking their opinion on the format of questions and making necessary changes , once , no further correction was required , the final survey was sent to 100 anesthesiologists , selected randomly from each hospital . sixty - four respondents had > 10 years of experience while 7 respondents had 5 - 10 years and 2 had < 5 years of experience after postgraduation . thirty - three anesthesiologists ( 45% ) always wore gloves before laryngoscopy , while 16 ( 22% ) admitted that they never wear gloves . all 73 respondents ( 100% ) agreed that laryngoscope can be a source of hai . thirty of the 73 respondents ( 42% ) would not use a randomly selected laryngoscope from their institution for personal use . fifty - one out of 73 respondents ( 70% ) have never used a disposable laryngoscope blade . of the remaining 22 using disposable laryngoscopes , forty - six anesthesiologists ( 63% ) acknowledged a well - defined protocol in their hospital [ figure 1 ] . however , on further evaluation , it was found that the anesthesiologists from the same hospital were following different protocols . protocol for cleaning / decontamination of laryngoscope blades with regard to the cleaning and disinfection policies adopted in the institute , 29 respondents ( 40% ) clean the laryngoscope blade after usage by initially washing with soap and then running tap water , whereas 23 respondents ( 32% ) clean using brush with soap and water [ figure 2 ] . forty anesthesiologists ( 54% ) admitted that they do not disinfect laryngoscope blade , while only 16 ( 22% ) put the used laryngoscope blade in the chemical disinfectant after cleaning [ figure 3 ] . forty - three anesthesiologists ( 59% ) informed that cleaning - disinfection technique is modified depending on the perceived risk of infection . techniques of cleaning laryngoscope blades techniques of disinfection of laryngoscope blades sixty - seven respondents ( 92% ) informed that ot technical staff is responsible for cleaning of laryngoscopes , but only 50 ( 68% ) agree that the staff members responsible for cleaning the laryngoscope have been trained accordingly . regarding laryngoscope handle , only 25 respondents ( 34% ) rest 48 either do not clean it at all or do it once in a day at the start or end of operation theater [ figure 4 ] . there is no fixed way of handling the soiled laryngoscope blade after use : it is kept in the intubation tray ( 29 ) , handed over to the technician ( 23 ) , kept by the side of patient head ( 13 ) , or on the machine ( 8) . after decontamination , for placement of a clean laryngoscope , 52 respondents keep it in the sterile intubation tray for subsequent use while 21 keep it in the pouch / box supplied by the manufacturer , or in the drug tray or in the anesthesia machine drawer . . however , the role of the laryngoscope in the spread of infection is often not well appreciated by its users . moreover , there are studies which have shown the presence of visible or occult blood on the laryngoscope blade and handle making the equipment a potential source of cross - infection . the laryngoscope blade which comes in direct contact with the patient mucosa in the oral cavity is often cleaned and decontaminated . in the present survey , 23 respondents ( 32% ) do not clean the handle . although the laryngoscope handle does not come into direct contact with the patient 's oral mucosa , it is reported to get contaminated by the tip of the folded blade . call et al . found high - level of bacterial contamination of laryngoscope handles despite low - level disinfection . literature reveals that various methods have been unsuccessfully tried to prevent the spread of infection associated with the laryngoscope contamination . these include the usage of sheaths and condoms to cover the blade and handle . according to food and drug administration guidance document , use of a sheath to cover the laryngoscope does not eliminate reprocessing of its blade or handle . these include the use of use of chemical disinfectants ( low - level and high - level ) , autoclaving , gamma radiation , gas sterilization , and plasma sterilization . the results of our survey reveal that cleaning with soap and water with or without a brush is the commonest technique being followed by 52 respondents ( 72% ) . forty anesthesiologists ( 54% ) admitted that use of disinfectant is not a common practice , and they do not disinfect the blade . literature reveals that even if low - level disinfectants are used , they do not provide adequate decontamination . however , autoclaved laryngoscopes must have batteries replaced , be reassembled and checked for function prior to use , exposing them to repeated handling and thus potential contamination following sterilization . in the present survey , autoclaving of laryngoscope blade was performed by only 16 anesthesiologists ( 22% ) . there are well - documented guidelines for decontamination of laryngoscopes in various countries . however , there are no such documented guidelines available in india from any professional organization . spaulding in 1968 had classified the patient care equipment as critical , semi - critical and noncritical based on the degree of risk of infection . all airway related equipment , since they come in direct contact with patient mucosa , are classified as semi - critical devices . regulatory bodies like the joint commission ( usa ) emphasized the importance of standardizing the reprocessing and storage of the laryngoscope 's blade and handle to reduce the risk of infection . centre for disease control ( cdc ) and american society of anesthesiologists recommend cleaning and high - level disinfection or sterilization for the laryngoscopes . the guidelines for decontamination and reprocessing of laryngoscope blade and handle had been described by muscarella and california department of health sciences . from the available literature , the ideal technique to prevent any laryngoscope associated infection would be the single use of a disposable laryngoscope . however , its use is not encouraged because of concerns about the efficiency of single - use blades during laryngoscopy in terms of significant increase in complication rate and increase time to intubate with disposable blades . the result of the present study showed that 51 respondents ( 70% ) had never used disposable blades . amongst 22 who are using disposable blades the result of this study revealed that there are no fixed practices , and there is marked variability in the techniques of handling used laryngoscope , cleaning , decontamination , and subsequent storage . the present survey reveals that the laryngoscope is accepted to be a potential source of infection by all the respondents , and it should be free from contamination prior to use . disruption at any of the step of reprocessing of the laryngoscope would amount to compromising patient safety . there is imminent need to develop the guidelines for laryngoscope decontamination in the interest of patient care which can be implemented in india .
background and aims : india is a vast country with variable , nonuniform healthcare practices . 
 a laryngoscope is an important tool during general anesthesia and resuscitation . 
 the study aimed to determine the current practices of laryngoscope decontamination in india.material and methods : an online survey was conducted amongst 100 anesthesiologists to determine the common methods of laryngoscope decontamination adopted in their settings . 
 the survey was done over 6 months after validating the questionnaire.results:a total of 73 responses were received out of 100 . 
 the result of the survey revealed that there is no uniform technique of laryngoscope decontamination . 
 there is marked variability in techniques followed not only among different institutions , but also within the same institution.conclusion:there are no fixed protocols adopted for laryngoscope decontamination . thus , there is a need to develop definitive guidelines on this subject , which can be implemented in india .