Survey of nasopharyngoscope decontamination methods in Canada.

BACKGROUND: nasopharyngoscopes are essential tools in modern otolaryngology practice. Owing to their frequent and diverse use, it is important to ensure that they can be efficiently and thoroughly cleaned. To date, there are no official national guidelines provided by the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) for decontamination of nasopharyngoscopes. OBJECTIVE: to compare flexible nasopharyngoscope decontamination practices across Canada. METHODS: a questionnaire regarding nasopharyngoscope cleaning procedures was distributed online to all otolaryngologists registered with the CSOHNS. The survey was anonymous. Topics addressed province, practice type, maintenance, operations, ventilation, and process development. RESULTS: thirty-five percent of the 505 Canadian otolaryngologists contacted participated in the survey. Automated sterilization of nasopharyngoscopes is employed by 16% of participants, of which the majority of this use is in hospital settings. Over 61.3% of participants use a multistep decontaminating soak for cleaning. Decontamination procedures were created within the department in 59% of cases, and over 28.3% of participants are unsure as to whether their procedures adhere to infectious disease and industry standards. CONCLUSION: various procedures are employed throughout Canada owing to a lack of standardization. Survey responses indicate that Canadian otolaryngologists would appreciate a national standard for the cleaning of flexible nasopharyngoscopes, particularly for nonhospital practices.

Prevention of postlaryngectomy pharyngocutaneous fistula: the Memorial University experience.

OBJECTIVES: The purpose of this study was to compare the efficacy of a pectoralis major myogenous flap in the prevention of pharyngocutaneous fistula in patients who have undergone total laryngectomy. Our secondary objective was to estimate the economic saving to our health care system. DESIGN: Retrospective clinical study. SETTING: Grace General Hospital, St. Clare's Mercy Hospital, H. Bliss Murphy Cancer and Research Centre, St. John's, Newfoundland. MATERIALS AND METHODS: Two hundred and twenty-three consecutive total laryngectomy procedures performed between June 1978 and December 2001 were reviewed. The fistula rate in laryngectomy patients prior to 1988 without pectoralis major myogenous flaps (group A) was compared with that of patients after June 1988 who had this flap routinely used at primary surgery (group B). Analysis of risk factors within those two groups was essentially similar. RESULTS: In group A, the overall pharyngocutaneous fistula rate was 22.9%. The fistula rate in group B was less than 1%. CONCLUSION: Our study has demonstrated that at our tertiary care head and neck oncology centre, we have dramatically decreased the incidence of postlaryngectomy pharyngocutaneous fistula. By the routine addition of a pectoralis major myogenous flap to cover the pharyngeal defect at surgery, we have substantially and dramatically reduced patient morbidity and mortality and reduced hospital stay, with major financial savings to the health care system.