Comparing and optimizing ultraviolet germicidal irradiation systems use for patient room terminal disinfection: an exploratory study using radiometry and commercial test cards.

Background: Ultraviolet germicidal irradiation (UVGI) systems are gaining popularity, however objective comparisons of their characteristics are lacking. While environmental cultures and reduction of hospital-associated infections rates are excellent study endpoints, they are impractical for centers with limited resources who want to compare or optimize UVGI systems use. Methods: We evaluated radiometry and commercial test cards, two simple and low cost tools, to compare 2 full size UVGI systems (Tru-D and Optimum-UV Enlight) and 2 small units (Lumalier EDU 435 and MRSA-UV Turbo-UV). Results: Radiometry-derived output curves show that if both large devices emit enough energy to reach C. difficile lethal doses at 10 ft, the reduction in output in distance is almost perfectly logarithmic. In a patient room environment, Enlight and Tru-D performed similarly when compared using radiometry and commercial test cards. The two small devices reached C. difficile range around the bathroom with the device raised above the floor, but longer times are needed. Conclusions: Despite different workflows and price points, no clear superiority emerges between Tru-D and Enlight. Bathroom disinfection should be dealt with separately from the main room and small, cheaper units can be used. Radiometry and commercial test cards are promising ways to compare UVGI systems, but further validation is needed using correlation with environmental cultures. Trial registration: Not applicable.

A comparison of the King-LT to endotracheal intubation and Combitube in a simulated difficult airway.

BACKGROUND: Prehospital endotracheal intubation (ETI) is a complex skill to maintain proficiency. Several airway adjuncts are available for prehospital providers. A recent alternative is the King Laryngeal Tube (LT) approved for use by the FDA in 2003. The aim of this study was to determine if the King-LT offers improved placement success and times over the Combitube (ETC) and endotracheal tube (ETT) in a simulated difficult airway. METHODS: Sixty-nine prehospital providers (EMT-Bs and EMT-Ps) were timed in a series of trauma scenarios involving the placement of an ETT, ETC, and LT in a difficult airway simulator. Primary outcome measures were placement time (seconds) and success for each device. Successful placement in the manikin was defined by adequate placement depth, inflation of device cuffs, the presence of breath sounds, and the absence of epigastric sounds. RESULTS: EMT-P mean placement times were 91.3 seconds (76.6-106.0) for ETT, 53.7 seconds (48.3-59.1) for ETC, and 27.0 seconds (24.3-29.7) for LT. EMT-B mean placement times were 46.4 seconds (37.5-55.3) for ETC and 22.5 seconds (19.0-26.0) for LT. Subgroup analysis was completed and compared in groups that either checked or did not check device balloons prior to insertion. EMT-Ps successfully placed an ETT in 68.9% (31/45) of attempts. EMT-P success for ETC and LT scenarios were 82.2% (37/45) and 100% (45/45). EMT-B success in the ETC was 87.5% (21/24) and 100% (24/24) with the LT. Differences in successful placement between all devices were significant for paramedics only. A survey was provided following the scenarios to assess comfort and ease of each device; 17/45 EMT-P participants noted the ETT to be "difficult" to place versus 38/45 reporting the King-LT to be "easy" or "very easy." CONCLUSIONS: The King-LT is a relatively new airway device with time and successful placement advantages over ETT and ETC.

A pilot study of the King LT supralaryngeal airway use in a rural Iowa EMS system.

INTRODUCTION: In 2003, the King Laryngeal Tube (LT) received FDA approval for US sales. Prehospital systems in urban setting have begun evaluating and adopting the LT for clinical airway management. However, it is not routinely approved by State EMS Boards for use by all prehospital providers. Given the LT's simple design there may be benefit to using this tool for airway management in all levels of prehospital providers. This pilot study reviews cases where the King LT was used in a rural Iowa county EMS system. METHODS: In 2006, the Iowa Department of Public Health / Bureau of EMS approved a 12 month pilot evaluating the King LT by all levels of EMS providers in a rural county EMS system. Following a didactic and competency training session on using the King LT, the providers were instructed to continue airway management per usual protocol but were allowed to use the King LT as a first line airway tool if they felt indicated. Successful placement of airway devices used were determined by colourimetric end-tidal CO2, chest auscultation and rise as well as vital sign and skin colour improvement. Review of the data was approved by the University of Iowa Institution Review Board (IRB). RESULTS: During the 12-month pilot period, the King LT was used in 13 patients with a mean age of 60.7 years (24-81). All patients had cardiopulmonary or traumatic arrest. The King LT was successfully placed on the first attempt in all but one case. The King LT was placed following endotracheal intubation failure in 6/13 (46.1%) cases and in 3/13 (23.1%) of cases of Combitube attempt / failure. CONCLUSIONS: This small pilot project emphasizes the need for additional rapid airway management tools given the demonstrated ETI failures. The authors believe the King LT has significant potential to impact prehospital airway management as a primary airway device or backup to other failed strategies. Further study is necessary to evaluate the LT's efficacy compared to current strategies.