AD.5 Care and cleaning of Anesthesia equipment

The anesthesia provider is responsible for anesthesia infection control and care of equipment and materials.  If there is no anesthesia provider on site, these responsibilities will be assumed by appropriate clinical staff. 
Anesthesia equipment that comes in contact with the vascular system or sterile body tissue should be sterile at the time of use. Aseptic technique will be used when preparing medications. 
1. Prior to this proper hand hygiene will be performed.
2. Vial stoppers will be cleaned with an alcohol swab before puncturing
3. No transference of syringes of unused medication between patients
4. Use multiple needles to withdraw medication into multiple syringes
Anesthesia equipment that comes in contact with mucous membranes should undergo disinfection before use.
1. Reusable items (e.g. airways, breathing circuits, connectors, forceps, masks, self inflating bags, some laryngeal mask airways (LMAs), transducer tubing, trans-esophageal probes are considered semi-critical.  The CDC has determined that their potential for transmitting infectious agents is significant and has classified these items as semi-critical. Most of these devices at our organizations are kept in sterile packaging, and discarded after use.
2. Reusable semi-critical devices which are not disposable, such as endoscopes, are cleaned by  pre-rinsing with cold water, washed with an enzymatic detergent, scrubbed with a brush, rinsed, and dried, as the first step in re-processing. Rigid laryngoscopes should be disassembled and all components cleaned, including  handles. Brushes used for cleaning are disposable or undergo high level disinfection at the end of the day.
3. The cleaned, semi-critical reusable items should be processed either by steam sterilization or by high-level
 disinfection, (which is tested prior to use for potency and dated for expiration)  or sterilization with a US Food
 and Drug  Administration (FDA)-approved agent.  Written  instructions from the manufacturers of reprocessing 
 equipment, chemicals, and instruments should be followed.  When using liquid disinfectants for high-level 
 disinfection, all internal and external surfaces must be in contact with an EPA registered disinfectant for the 
 time indicated by the manufacturer.
4. Residual chemicals should be removed and the reprocessed item thoroughly dried before storage or use on a patient. 
 Failure to remove residual chemicals  have led  to allergic reactions and tissue burns. The items should 
 be stored in a manner that minimizes the risk of re contamination or damage. Clean water should be used when rinsing the equipment.  If tap water is used for rinsing the equipment this process should be followed by a 70 percent alcohol rinse.
5. Personnel should be trained in the reprocessing procedures and equipment.  Training personnel regarding
the complexities of the equipment, chemicals, and processes used minimizes the risk of human error. Also all personal must understand the infection control process and utilize personal protective equipment to reduce the risk of exposure to pathogens, injury and exposure to cleaning agents. Personnel must be apprised of the hazards in the workplace, including chemicals used for reprocessing anesthesia equipment.   Personnel that are responsible for this process will have competency in the reprocessing method, proven as part of their initial and annual employee review. 
6. Once a semi-critical device has been sterilized or high level disenfection has occurred, the article is kept
   clean by maitaining the sterile packaging, or by storing it away from traffic. 

Anesthesia equipment contacting intact skin should be cleaned at the time of use.
1. Items such as blood pressure cuffs, electro-cardiogram leads, and oximeter probes that contact only intact skin 
are considered non-critical. These items and surfaces contacting  intact skin should be cleaned at any time they may become visible soiled or contaminated
2. Reusable laryngoscope handles should be cleaned and low-level disinfected (wiped with a germicide) between 
   patients.  Laryngoscope handles can become contaminated during airway management.
3. Reusable non-critical items should be low-level disinfected between patients with a EPA registered 
4. Surfaces of anesthesia equipment that are touched by personnel while they are providing patient care or 
   handling contaminated items should be cleaned and low-level disinfected between use on patients, according to  manufacturers' written instructions. 
5. A germicidal solution will be used to clean all surfaces of the anesthesia equipment on a daily basis, additional to cleaning at any time equipment may have become contaminated.
Single-use items should be used once and discarded in accordance with local, state, and federal regulations.
1. Single-use items should be used for a single patient and not reused on subsequent patients. 
2. Additionally, bio-hazardous waste should be placed in a bio-hazardous waste bag as indicated.
3. Sharps should be handed in a manner that minimizes the risk of percutaneous injury. To minimize the risk of 
   injury from contaminated sharps, OSHA requires that puncture-resistant sharps containers be located at the 
   point of use. Sharps should be placed immediately into the container
Anesthesia equipment should be handled, cleaned, processed, or discarded in the same manner in all areas of the practices setting. Equipment that is located in satellite areas or offices is treated in the same manner as equipment located in the main facility.
Internal components of the anesthesia machine breathing circuit should be cleaned regularly
1. Anesthesia ventilator bellows should be cleaned regularly according to manufacturers' written instructions. 
2. Soda-lime canisters are to be changed according to the manufacturer's written instructions. 
No items should be considered reusable when used with an infected patient.  All items, including soda-lime, are to be discarded at the conclusion of a case on a patient with a known infection.

Approved By Governing Board
Control #40.3