this is to increase the awareness of anaesthesia equipments decontamination

1. DECONTAMINATION OF ANAESTHESIA
EQUIPMENTS
DR. CHETAN SHAH
M.D.
Consultant Anaesthesiologist and
pain management
VADODARA

2. ARE WE responsible for transmitting the
infection and hence increasing the
Health Care Associated Infections
(HCAIs)????

3. STUDIES/EVIDANCES
• In 1932, Waters was the first to recognize
anaesthetic equipment as a vector for
nosocomial pathogens.
• Organism has been isolated from anaesthetic
equipment, and transmission of infection
from such apparatus to patient has been
confirmed in a number of instances (Joseph,
1952; Wyant and Nanson, 1957; Tinne et al.,
1967; Old et al., 1972).

4. STUDIES/EVIDANCES
• Cross-infection from self-inflating breathing
bags (Cartwright and Hargrave, 1969),
humidifiers (Grieble et al., 1970), and
ventilators (Phillips and Spencer, 1965) is now
well documented.
• Babington, Baker and Johnston (1971) have
even demonstrated the upstream spread of
bacteria along the expiratory tubing of
ventilator circuit.

5. STUDIES/EVIDANCES
• Laryngoscopes have been implicated in the
nosocomial spread of Pseudomonas
aeruginosa and methicillin-resistant
Staphylococcus aureus.
• In 1996, the Association of Anaesthetists of
Great Britain and Ireland (AAGBI) reported on
the risk of blood-borne virus transmission
and anaesthesia.

6. STUDIES/EVIDANCES
• Evidence that hepatitis C may be transmitted
via anaesthesia breathing circuits, as well as
the emergence of multiple resistant
tuberculosis.
• More recently, the role of anaesthesia airway
devices in the transmission of variant
Creutzfeldt–Jakob disease (vCJD) has been
considered by both the Department of Health
and the Royal College of Anaesthetists.

7. STUDIES/EVIDANCES
• Canadian Anaesthetists’ Society
– Of 50 Bain circuits examined immediately
following their use on patients, four were found to
have become contaminated.
• P. J . Bennett D. H. P. Cope R. E. M. Thompson
– Five of twenty-five lengths of tubes examined
were contaminated with pathogenic bacteria;
three with Ps. aerugiitosa, one with Escli. coli and
one with Staph.

8. IT CONCLUDES
• There is no doubt that, over the years,
anaesthesia equipment has been responsible
for outbreaks of nosocomial infection.
• A contamination rate of 8 per cent is far too
high to permit consideration of re-use of these
circuits on the susceptible patient without
resterilisation.

10. Decontamination
• The removal of micro-organisms and
unwanted matter from contaminated
materials or living tissue.
It always involves cleaning followed by
disinfection and/or sterilization.

11. Cleaning
The physical removal of foreign material
including infectious agents and organic matter.
This does not necessarily destroy infectious
agents .

12. Disinfection
A process that eliminates many or all
pathogenic organisms except bacterial spores.
Chemicals used to disinfect the objects are
called disinfectants.
Chemicals used to disinfect body surfaces
are termed antiseptics.

13. Sterilization
A process that renders an object completely
free of all viable infectious agents by
eliminating all forms of microbial life.

14. • Why surgeon sterilise every thing before use?
Because they are
CRITICAL ITEMS

15. Classification of devices
All medical instruments are divided into three
categories according to degree of risk of
infection they carry
• CRITICAL ITEMS
• SEMI-CRITICAL ITEMS
• NON-CRITICAL ITEMS

16. CRITICAL ITEMS
• Objects which enter normally sterile tissue or
the vascular system or through which blood
flows.
– This category includes surgical instruments,
cardiac and urinary catheters, implants and
needles etc.

17. SEMI-CRITICAL ITEMS
• Objects that touch mucous membranes or
skin that is not intact .
– examples include laryngoscopes, fibre-optic
endoscopes and thermometers, breathing circuits
etc.

18. NON-CRITICAL ITEMS
Objects that touch only intact skin .
Examples include blood pressure cuff,pulse
oximeters probe, ECG leads etc.

19. HOW TO DECONTAMINATE?
• All items first to be CLEANED.
• Critical items requires STERILISATION
• Semi critical items requires HIGH LEVEL DIS-
INFECTION
• Non critical items requires LOW LEVEL DIS-
INFECTION

20. Service cycle of medical device

21. Cleaning
Why Cleaning is important ?
• To prevent spread of infections between
patients.
• To ensure that the anaesthesiologist does not
contact infections from equipments .

22. Cleaning
• The objectives of cleaning are:
• (1) To reduce the number of organisms to be
destroyed.
• (2) To remove pyrogens, tissue fragments and
organic deposits which may be toxic to the
patient and interfere with the decontamination
process.
• (3) To prevent the cumulative deterioration of
equipment.
• (4) To meet hygienic anaesthesia standards.

23. Cleaning
• The water temperature should not exceed
45°C
• Cleaning before disinfection/sterilisation to
removes bioburden (Populations of viable
infectious agents contaminating medical
device.)

24. Cleaning
• It is performed by manual or automated
mechanical methods.
• Instruments should be dismantled

25. Automated methods
• Automated methods have largely replaced
manual cleaning
• Ultrasonic Cleaners and Washer / Sanitizers /
Disinfectors/ Sterilizers

26. Ultrasonic cleaners
• For equipments having joints, crevices, lumens
Detergent added to liquid
• Time limit – 3 to 6 min.
• Advantage – superior to hand washing
• Drying - Towel drying, Air drying

27. DISINFECTION
TYPES:-
Low level disinfection
Intermediate level disinfection
High level disinfection

28. Low level disinfection
• Kills
– most vegetative bacteria(except mico and endo
spores)
– some viruses
– some fungi
• Alcohol and Quaternary Ammonium
compounds are examples.

29. Intermediate level disinfection
• Kills
– most vegetative bacteria(including mico)
– most viruses
– most fungi
– No spores
• Alcohol, sodium hypochlorite,Phenols, and
Iodophors are examples.

30. High level disinfection
• Kills
– Vegetative bacteria(except endo spores)
– Micobacteria
– Fungi
– Viruses
• Aldehydes, Peracetic acid, and Chlorine
dioxide are examples.

31. Comparison
LEVELS OF DISINFECTION
LEVELS BACTERIA LIPID &
MEDIUM
SIZED
VIRUSES
NON LIPID
OR SMALL
SIZED
VIRUSES
VEGETATIVE TUBERCLE SPORES FUNGI
HIGH + + +/- + + +
INTERMEDIATE + + - + + +/-
LOW + - - +/- + -

32. STERILISATION
• Kills
– All bacteria/viruses/spores
– Render a device free from infectious agents

33. STERILISATION
• Terminal sterilization :- sterilization process
carried out after final packaging of the item.
• Sterility Assurance Level (SAL) :- the probability
of survival of micro-organisms after a terminal
sterilization process & is predictor of efficacy of
the process.
• A SAL of 10−6 is deemed appropriate for ‘sterile
devices’; this means that the probability of an
organism surviving on the device is 1 in a million.

34. Modes
• OF DISINFECTION
– CHEMICAL
– PASTURISATION
• OF STERILISATION
• CHEMICAL
• STEAM
• GAS
• PLASMA
• RADIATION

35. Chemical agents
• Glutaraldehyde(cidex)
• Paracetic acid
• Formaldehyde
• Alcohol
• Quaternary Ammonium Compounds
• Phenolic Compounds
• Iodophors
• Chlorine and Products
• Hydrogen Peroxide

36. Glutaraldehyde (cidex)
• It is a saturated dialdehyde. It is used
in 1.0% concentration (but highly
effective in 2% concentration).
• It is high level disinfectant. It kills
spores within 12 hrs and viruses
within 20 min.

37. Glutaraldehyde (cidex)
• Widely used because
– excellent biocidal properties,
– activity in the presence of organic
matter,
– less corrosiveness and
– noncoagulation of proteinaceous
material.
• The manufacturers state that it retain
its effectiveness for up to 14 days
after initial use.

38. Glutaraldehyde (cidex)
Disadvantages :
• It is noxious and irritating to tissues
and hence thorough rinsing of all
exposed materials is mandatory.
• Prepackaging is not possible and
equipment will be wet.
• Pseudo-membranous laryngitis has
been linked to disinfection of tracheal
tubes with glutaraldehyde.

39. PERACETIC (PEROXYACETIC) ACID
• It is acetic acid with an extra oxygen atom.
• It is bacteriocidal, sporicidal, fungicidal and
viricidal.
• They are effective in the presence of organic
matter
• It will replace cidex because of its short duration
(5-10 min)

40. PERACETIC (PEROXYACETIC) ACID
• Used in wide variety of heat sensitive and
delicate instruments.
• Used on wet or dry items and there is no
personnel exposure. It can be situated in the
Operating room suite.
• Corrosive and irritating to skin in concentrated
solution.

41. FORMALDEHYDE:
• It is a high level disinfectant.
• For better effect it needs relative humidity of
60-80% and temperature of 37°C.
• Limited by its pungent odor and fumes.
• Should be handled as a potent sensitizer and
probable carcinogen.

42. ALCOHOL
• Intermediate level disinfectants.
• Ethyl alcohol is bactericidal in 60-90%
concentration and isopropyl alcohol in
60% concentration.
• Recommended exposure to 70%
ethanol for 15mins to inactivate the
hepatitis virus but 1 min for HIV.
• Their effectiveness is limited because of
rapid evaporation, lack of ability to
penetrate organic matter.

43. ALCOHOL
• They are used mainly to
disinfect external surfaces of
equipment like stethoscopes,
ventilators, fiberoptic cables.
• They can damage mounting of
lensed instruments and tend to
swell and harden rubber.

44. QUATERNARY AMMONIUM
COMPOUNDS (QUATS)
• Low level disinfectants
• They are effective against gram positive
than gram negative and marginally
effective against Pseudomonas. They
inactivate HIV but not hepatitis virus.
• They are inactivated by organic
materials.
• Side effects are allergic reactions and
contact dermatitis.

45. PHENOLIC COMPOUNDS
• They are intermediate to low level disinfectants.
• Derived from carbolic acid (phenol), one of the
oldest germicides.
• They are active in the presence of organic matter.
• They are irritant to skin & mucous membranes, have
bad odour.
• They are absorbed by rubber and residual
disinfectant may cause tissue irritation.

46. Chlorhexidine (Savlon) :
• It is a non detergent
chemical disinfectant usually
used in the concentration of
0.5% in 70% alcohol for skin.
• Tubes, masks etc. are
sterilized by keeping for 20
min in 0.1% aqueous
solution.
Chloroxylenol (Dettol):
• It is used as mild antiseptic
agent

47. IODOPHORS
• It is a combination of iodine and
carrier with a resulting complex
providing sustained release
reservoir of iodine.
• These are intermediate to low
level disinfectants.
• They corrode the metallic items
and non-metallic items may be
stained or discolored.

48. CHLORINE AND CHLORINE PRODUCTS
• They are intermediate level
disinfectants.
• They are available both in liquid
(sodium hypochlorite) and solid
(Calcium hypochlorite) forms.
• They are most widely used,
inexpensive and fast acting.

49. CHLORINE AND CHLORINE PRODUCTS
• Highly effective against HIV.
• Household bleach is an inexpensive and
excellent source of sodium hypochlorite.
• A 1:100 to 1:1000 dilution is effective
against HIV.
• 1:5 to 1:10 dilution is effective against
hepatitis.
• It also inactivates Cruetz Feldt Jakob
disease with an exposure time of 1 hr.

50. Hydrogen peroxide
• It is an effective bactericidal, fungicidal,
viricidal and sporicidal.
• It is commercially available as 3% solution but
can be used upto 25% concentration.
• It is non corrosive and not inactivated by
organic matter but irritant to skin and eyes.

51. Ozone:
• Sterilizers use O2, water & electricity to produce Ozone.
Advantages:
• Useful for most goods that need low temperature
sterilization.
• Process is environmentally friendly.
• Treated objects are dry.
Disadvantages:
• Not approved for flexible scopes & reactive materials
such as copper & brass.
• Unsuitable for natural gum rubber products

52. Chemical Disinfectant/steriliser
• Sterilisers
– Glutaraldehyde (> 2.0%) ,
– Peracetic acid(0.2%)
– Hydrogen peroxide(7.5%) are examples.
• High-level disinfectants
– Gluteraldehyde
– Stabilized hydrogen peroxide
– Peracetic acid
– Chlorine and chlorine-releasing compounds.
• Low-level disinfectants
– Alcohols
– Sodium hypochlorite
– Iodophore solutions.

53. Factors Influencing Chemical Sterilization
a) Concentration of the Chemical:
Rate of kill of bacteria varies directly with the
concentration of the disinfectant.
b) Temperature:
Designed to be used at room temperature.

54. Factors Influencing Chemical Sterilization
c) Evaporation and light deactivation:
Volatile agents evaporate easily. Exp: Chlorine
Products. Exposure to light adversely affects
the disinfectant.
d) PH:
Alcohols work best in alkaline PH while
aldehydes work best in acidic PH.

55. Factors Influencing Chemical Sterilization
e) Bioburden:
The effectiveness of the disinfectant depends
on the nature and number of contaminating
microorganisms
f) Characteristics of the item to be sterilized:
A disinfectant solution will be effective only if it
can contact all the surfaces on the item.

56. Factors Influencing Chemical Sterilization
g) Time:
Time required for different chemical agents to
function effectively varies from seconds to
hours.

57. Factors Influencing Chemical Sterilization
h) Use Pattern, Use Life & Storage Life:
• Use Pattern refers to how many times the
solution can be used.
• Use Life indicates limited period of time
during which activated solution can be used.
• Storage life is the time period after which the
unused or inactivated product is no longer
deemed effective.

58. Chemical Disinfection/Sterilisation
• Advantages
–Convenient
–Rapid
–cheap

59. Chemical Disinfection/Sterilisation
• Disadvantages
– Toxic
– Flammable
– Act only on exposed surfaces
– Unpleasant odor and irritability
– Corrosive or Chemically incompatible with certain
devices
– Absorption of chemicals into items
– Can recontaminate during rinsing, drying, wrapping

60. Disinfectant Gm +ve
Bacteria
Gm –ve
Bacteria
Tubercle
bacillus
Spores Viruses Fungi
Formaldehyde + + + - +
QUATS + + - - + +
Phenolic compounds + + +/- - + +
Alcohol + + + - + +
Chlorine + + + - + +
Hydrogen Peroxide + + + +/- + +
Glutaraldehyde + + + +/- + +

61. Pasteurisation
• Water at temperatures
of 77°C for a period of
30 min to achieve
intermediate-level
disinfection
• Breathing tubes, ETT,
Reservoir bags,
Facemasks, Airways,
Laryngoscope,
Ventilator bellows

62. Pasteurisation
• Advantage
– low temperature to
avoid damage
– No toxic fumes or
residues
• Disadvantage
– wet equipments so
needs time to get dried ?
– risk of contamination
again

63. Steam Sterilization
• Uses saturated steam under pressure
• Equipments to be closed first, packed in linen
or paper
• Steam circulated through chamber, maintains
temperature

64. TEMPERATURE
(°C)
PRESSURE
(lb/in2)
TIME (MIN)
121 15 15
126 20 10
134 30 3.5
150 50 Few Seconds

65. Advantages
• Kills all bacteria,viruses,fungi
• Speed
• Good penetration
• Economy
• Easy of use

66. Disadvantages
• Damages heat sensitive equipments
• Causes blunting of cutting edges
• Corrosion of metal surfaces

67. Monitoring
• Mechanical Monitors
• Biological Indicators
• Chemical Indicators

68. Mechanical Monitors
• Sterilizer components that gauge & record
time, temperature, humidity pressure during
sterilizing cycle.

69. Biological Indicator
• Most accurate method of checking
sterilization effectiveness.
• They contain a population of non-pathogenic
spore-forming organisms that are highly heat
resistant.

70. Biological Indicator
• Commercially prepared test packs are
available.
• To be done once a week.

71. Chemical Indicator
• It is sterilization process monitoring device
designed to respond with a characteristic
chemical change to one or more parameters
of sterilization cycle.

72. Chemical Indicator
Indicator tape, Colour change cards and Sealed
glass tubes with pellets that melt once
favorable time and temperature conditions
are attained.
Indicator tape should be on all packages
sterilized. The stripes that appear only serve
to distinguish processed from unprocessed
packages. Indicators are also placed inside
test packages to check performance.

73. Chemical Indicator
• These are divided into 6 classes, higher the
class, more sensitive the indicator.

74. • Class 1-
– These are Internal & External Process Indicator
– These inform that item has been exposed to
sterilization process.
– E.g. External Process Indicator – Autoclave Tape.

75. • Class 2-
—E.g. Bowie-Dick test for vacuum steam sterilizer.
—They only access Vacuum Pump efficiency &
detect the presence of air leaks &/or gases in
steam.

76. • Class 3-
—E.g. Temperature Tube.
—Contains chemicals that melts & sometimes
changes color when the appropriate temp is
attained.
• Class 4-
—Respond to one or more sterilization
parameters.
—Contains Ink that changes color when exposed
to correct combination of sterilization
parameters.

77. • Class 5-
—Known as Integrating Indicators or Integrators
—Respond to all parameters of sterilization over a
specified range of temperatures.
• Class 6-
—These are emulating indicators.
—These are designed to react to all critical parameters
over a specified range of sterilization cycles for which
the stated values are based on the settings of the
selected sterilization cycles

78. Gas Sterilization
• Ethylene oxide is a colorless, poisonous gas
with sweet odor.
• Flammable.
• Kills bacteria, spores, fungi, viruses
• Costlier – so restricted to objects that might
be damaged by heat or excessive moisture

79. Advantages
• It is an effective sterilant for a variety of
medical devices.
• It offers rapid low-temperature sterilization.
• Does not have environmental problems
associated with EO.
• No personnel protection equipment are
needed.

80. Preparation for EO
• Verify suitability of
equipments.
• Disassemble, clean, dry items
before packing.
• Hollow bore products must
open at both ends.
• Items must be free of water
droplets.

81. Preparation for EO
• Relative humidity of 35% to
70% ;
• temperature of 18º C to 22º
C is recommended
throughout.
• Items to be loaded loosely.

82. Factors affecting EO sterilization
• Temperature
• Humidity
• Packaging
• Exposure time (1.5 to 6 hrs.)

83. Aeration
• Degassing or desorption after EO sterilization
to remove EO to a safe level.
• May be done passively (ambient) or in
mechanical aerator

84. Complication of EO sterilization
• Acute exposure of personnel causes Upper
respiratory complications,Eye irritation, Nausea,
Vomiting, Diarrhea, Drowsiness, Weakness etc.
• Repeated exposure can weaken structured integrity
of items.
• Liquid EO causes burns
• Chronic exposure Corneal burns, Neuropathy,
Anaemia Cataracts

85. Advantages of EO
• Effective against all organisms.
• Reliable.
• Damage to equipments is minimal.
• No recontamination due to package .

86. Disadvantages
• Fire or explosion hazard.
• Needs time for aeration.
• More costly.
• Frequent biological monitoring.

87. Other Methods
• Gamma Radiation
• Infrared radiation
• Ultraviolet radiation
• Gas plasma

88. Gamma Radiation
• Items are exposed to gamma rays from Cobalt-60
source.
• Non-polluting, Environment friendly process
• Does not leave any harmful residue.
• The sterility of the items is retained indefinitely,
as long as the packaging is intact.
• Sterilisation of equipment of any shape can be
achieved due to the high penetration ability of
gamma rays
• Costlier impractical for everyday use.

89. INFRARED RADIATION
• This is method of sterilization by dry heat
usually used to sterilize the syringes and small
instruments

90. ULTRAVIOLET RADIATION
• It is done by submitting the whole operation
area to the light but the staff has to be
protected from sun burn

91. Gas Plasma Sterilization
• Relatively new technique which has the
potential to displace ethylene oxide
sterilization
• For heat and moisture sensitive instruments
since temperature does not exceed 50°C and
sterilization occurs in low moisture
environments.
• In this system, hydrogen peroxide is the
precursor of active species of plasma.

92. Gas Plasma Sterilization
• Sterilise glass items, plastics, polyvinyl
chloride (PVC),metal items, electric and fiber
optic cables as well as rigid endoscopes.
• Not suitable for celluloric materials e.g.
cotton, powders, linen, paper etc.
• Advantages
– Non-toxic, Dry, Low-temperature sterilization with
a cycle time of only 75 min.

93. Gas Plasma Sterilization

94. P.J.BennettD.H.P.CopeR.E.M.
Thompson
• All methods for decontaminating have
serious practical drawbacks.
• Autoctaving -economically prohibitive due to
the rapid deterioration in the rubber of the
corrugated tubes and bags.
• Ethylene oxide -requires expensive special
apparatuss, skilled management and
prolonged sterilization and airing time.
• Formaldehyde -relatively inefficient

95. P.J.BennettD.H.P.CopeR.E.M.
Thompson
• Chemical- chlorhexidine or glutaraldehyde
require suitable soaking facilities, rinsing must
be scrupulous and draining and drying is a
problem.
• Pasteurisation - beset with problems of
floating loops of corrugated tubing and masks,
with resultant inadequate decontamination

96. P.J.BennettD.H.P.CopeR.E.M.
Thompson
• Lastly, the efficiency of all these methods
depends for success upon separate and
adequate initial washing to remove organic
material, such as sputum or blood, which
could protect the bacteria from the sterilising
agent.

97. A ‘one step’ washing machine
• The ideal method of decontamination is a
cheap ‘one-step’ procedure with a rapid
turnover requiring minimal handling and
therefore minimal staff. This procedure must
satisfy the following criteria:

98. A ‘one step’ washing machine
• 1 Thorough cleaning to remove all dried organic
matter.
• 2 Rinsing to remove all traces of detergent or
other chemical additive.
• 3 Sterilisation of vegetative organisms without
damage to equipment or risk or injury to the skin
or mucous membrane of patients and staff.
• 4 Adequate drying of equipment, including the
lengths of corrugated tubing, is essential if Ps.
aeruginosa contamination during storage is to be
avoided.

99. Barrow & Meynell reported the use of
a modified dishwashing machine

100. Barrow & Meynell reported the use of
a modified dishwashing machine

101. INDIVIDUAL ITEMS

102. Face masks
• Rinsed, soaked & scrubbed after
use.
• Wash with soap & water &
thoroughly dried.
• Keep in water at 60-70°C for
20min. this reduces number of
pathogens to very small no.
• Gas sterilization is v.effective
method.
• It should not be boiled as boiling
deteriorates masks

103. Laryngoscope Blades
• Boiled or Autoclaved after cleaning,
but they may spoil electric
connections.
• Gas sterilisation.
• Formalin oven can be used.
• Wiping with 70% alcohol or 0.1%
Chlorhexidine in 70%alcohol is
useful.

104. Tracheal tubes, Suction Catheters,
Airways
• Ideally disposable
• Washed with soap & water & rinsed.
• A malleable brush may be used to
clean the inner aspect of tubes &
airways.
• Boiling will sterilize it but tubes will be
softened.

105. Tracheal tubes, Suction Catheters,
Airways
• Chlorhexidine 0.1% solution can be
used. Here equipments should be
soaked for 30-60min for complete
sterilization.
• Autoclaving will be effective. But ETT
should be replaced after 6 uses.
• Gamma radiation is satisfactory.

106. Supraaglotic airway
• Ideally, supraglottic airways
designed for repeated use should be
sterilised no more often than the
manufacturer recommends.
• A supraglottic airway used for
tonsillectomy or adenoidectomy
should not be used again .
• The AAGBI recommends single-use
supraglottic airways.

107. Breathing tubes & Reservoir bags
• Wash thoroughly, rinse & allow
it to dry in air.
• Can be Pasteurized at 75°C for
10min.
• Chemical disinfection with
glutaraldehyde for 1hr can be
carried out by using automatic
washing machine or by
immersion. Tube should be
inserted vertically during
procedure

108. Y-piece
• Chemical disinfection.
• Ethylene oxide or Plasma
sterilization can be used.
• It can be soaked in solution of
water & detergent, then scrubbed
manually or placed in washing
machine.

109. Mapleson System
• Should be disassembled &
component cleaned
• Metal components can
undergo Autoclaving.
• Rubber & Plastic parts can
undergo Gas or Plasma
Sterilization.

110. Adaptors
• Rinsed & soaked in solution of
detergent & water.
• May be washed manually or in
washing machine.
• Rubber & plastic adaptors- sterilized
with EO, plasma sterilization or in
Glutaraldehyde.
• Metal adaptors may be autoclaved or
Pasteurized.

111. Unidirectional valves, APL valves &
Water Traps
• Cleaned & disinfected
periodically.
• They are disassembled &
cleaned by wiping disc. The
inside of the plastic dome & the
valve seat with alcohol or
detergent.
• Some APL valves may be
autoclaved & some may be
Pasteurized.

112. Gas Cylinders
• Washed with water & detergent.
• Then wiped or sprayed with
germicide

113. Circle Absorber
• Gamma radiation
• Ethylene oxide.
• Formalin chamber.
• Can be dismantled & disinfected
with spirit.
• Entry of organisms, while in use,
can be prevented by using filters.

114. Anaesthesia Carts & Machines
• Top surface should be cleaned of
visible material between cases.
• Bacterial ⁄ viral filter is used
between patient and circuit.
• Disinfected with germicide at end of
day

115. Ventilators
• Bacterial filters
• ETO of the complete respiratory
circuit before use,
• Internal irrigation with antiseptics,
provided the circuit is water tight.
• Some have breathing units which can
be autoclaved.
• Formalin Chambers can be used.

116. Blood pressure cuffs, Tubing's &
Stethoscopes
• Washed & dried thoroughly.
• Then subjected to chemical
disinfection or Gas Sterilization.
• Nonfabric cuffs – plasma
Sterilization is used.
• Stethoscopes can be washed
with water & wiped with alcohol.

117. Pulse oximeter probes & cables
• Cleaned by wiping with alcohol.
• Cables – Plasma sterilization

118. Endoscopes
• Detached all parts/ports etc
• Vigorous mechanical cleaning and
rinsing
• Internal channels to be brushed
• Gluteraldehyde 2% for 20 mints is the
agent of choice for high-level
disinfection of endoscopes
• Followed by thorough rinsing

119. Ultrasound probes
• Non-critical use. Following non-
invasive procedure it is
disinfected with a cloth soaked in
alcohol based solution (either
alcohol alone or alcohol
combined with antiseptic).

120. Ultrasound probes
• Semi-critical use. For invasive
procedures ( nerve block or central
venous catheterisation), the probe and
cable ideally should be covered with a
long sterile sheath. Any conducting
medium (for example, ultrasound gel)
between the probe cover and the skin
should be sterile.

121. Ultrasound probes
• The cleaning procedure should include
the entire cable from the transducer to
the machine and extend to the surface
of the machine.
• Any probe that is contaminated with
blood or other biological fluid should
be cleaned as for critical use.

122. Environmental surfaces
• It includes surfaces of medical equipment,
laryngoscope handles, infusion pumps,
equipment carts, anaesthesia carts, monitor
knobs, blood warmers, monitoring cables, and
other equipment not in direct patient contact.
• Intermediate or low level disinfection is the
acceptable mode of decontamination for this
category.

123. ORDER OF RESISTANCE
• In descending order are-
Prions
Coccidia (cryptosporodium)
Bacterial spores (bacillus)
Mycobacterium
Cysts
Small non-enveloped viruses (Polio)

124. Trophozites
Gram Negative Bacteria (Pseudomonas)
Fungi
Large non-enveloped viruses (adenovirus)
Vegetative Bacteria (Staph Aureus)
Lipid or medium sized viruses (HIV, Hepatitis B)

125. SPECIFIC DISEASE STATES
• TUBERCULOSIS
• As far as possible elective surgery on a patient
with TB should be delayed until the patient is
no longer infectious and if unavoidable,
single-patient use items should be used.
• High-efficiency particulate air (HEPA) filter
should be placed between the anaesthesia
circuit and the patient’s airway if patient with
confirmed or suspected tuberculosis.

126. SPECIFIC DISEASE STATES
• TUBERCULOSIS
• Reusable items that are used for these patients
should be subjected to sterilisation or high level
disinfection.
• 0.1% Chlorhexidine solution for 1hr, then it is
cleaned & scraped with soap & water & then
sterilized by boiling or autoclaving.
• Boiling for 3min will kill tubercle bacilli.
• It can also be immersed in 2%Glutaraldehyde
solution for 1hr.

127. SPECIFIC DISEASE STATES
• HepatitisB(HBV),HepatitisC (HCV)and HIV
• Autoclaving & Gamma Radiation.
• Chemical sterilization- Sodium Hypochlorite
50ppm,
• Glutaraldehyde 2% for 10 min.
• Iodophor 80ppm
• Isopropyl alcohol 70% for 15 min.

128. Prion diseases
• Transmissible Spongiform Encephalopathies
(TSEs).
• Progressive neurological degeneration.
• TSEs are caused by abnormal prions, which
are infectious proteins.

129. Prion diseases
• Microscopic traces of tissue often remain on
surgical instruments after washing and
autoclaving or disinfecting and any prion
protein in these traces could still transmit the
disease.
• Successive washing after use reduces the
concentration so that, after about 10
decontamination cycles, infectivity becomes
negligible.

130. Prion diseases
• Variant Creutzfeldt-Jakob disease (vCJD) is a
TSE caused by the same prion protein that
causes Bovine Spongiform Encephalopathy
(BSE) in cattle.
• Incubation period of several years.
• It is similar to sporadic CJD, which has been
spread by neurosurgical instruments, dura
mater grafts and pituitary extracts.

131. Prion diseases
• Sporadic CJD prion protein is to be found only
in brain, spinal cord and posterior eye,but in
vCJD, it can also be found in lymph nodes,
appendix and tonsils.
• Lymphoid tissue, including that of the adenoid
and tonsil, is of ‘medium infectivity’ for vCJD
and it is possible that a patient undergoing
surgery could be incubating this disease.

132. Prion diseases
• Surgeons routinely operate with traceable
reusable instruments in accord with latest
national advice, since single-use instruments
were associated with low risks of CJD transfer.
• Tracheal tubes, supraglottic airways and oral
airways should be destroyed after use for
these operations as they can be contaminated
by infectious tissue.

133. Prion diseases
Steps to reduce the risk of transmission
of prion disease
• 1 Adherence to the same universal
precautions as for other potential infections.
• 2 Minimising the use of transfusion of blood
and blood products.
• 3 Use of SSD decontamination and
sterilisation with tracing for all reusable
equipment.

134. Prion diseases
Steps to reduce the risk of transmission
of prion disease
• 4 Ensuring that any instrument that contacts the
brain, spinal cord or dura is destroyed afterwards.
• 5 The employment of single-use equipment when
this is as reliable and safe as the re-usable
alternatives.
• 6 Destroying or quarantining instruments used on
cases who may have CJD and for those known to
be at risk.

135. Prion diseases
• Steps to reduce the risk of transmission
of prion disease
• 7 Ensuring that all airway devices used during
tonsillectomy and adenoidectomy are
discarded after use.
• 8 For Critical Devices – Steam Sterilization for
30min at 132°C is recommended.

136. HOW DO I DO? SHOULD I DO?
• IF I AM WORKING IN
• Tertiary care corporate hospital.
• Multi specialty nursing home.
• Periphery.

137. HOW SHOULD I DO?
• WASH HAND

138. HOW SHOULD I DO?
• WASH HAND
• CHANGE CLOTH ON
TROLLY EVERYDAY

139. HOW SHOULD I DO?
• WASH HAND
• CHANGE CLOTH ON
TROLLY EVERYDAY
• ALL DISPOSIBLE
SYRINGES

140. HOW SHOULD I DO?
• BAIN CIRCUIT AND
VENTILATOR CIRCUIT

141. HOW SHOULD I DO?
• BAIN CIRCUIT AND
VENTILATOR CIRCUIT
• MASK (no cidex)

142. HOW SHOULD I DO?
• BAIN CIRCUIT AND
VENTILATOR CIRCUIT
• MASK (no cidex)
• LARYNGOSCOPE

143. HOW SHOULD I DO?
• ET TUBE
• AIRWAYS
• DISPOSIBLE
• ETO
• CIDEX
(Rs.500/- for
14 days)

144. HOW SHOULD I DO?
• ET TUBE
• AIRWAYS
• WEAR GLOVES
– (disposable/
examination)
• DISPOSIBLE
• ETO
• CIDEX
(Rs.500/- for
14 days)

145. HOW SHOULD I DO?
• DISPOSE OFF ALL USED
MATERIAL IN SAPERATE
VESSEL

146. GUIDELINES
• The Association of Anaesthetists of Great Britain and
Ireland (AAGBI) published guidelines of Infection Control in
Anaesthesia.
• In addition to AAGBI Officers and Council members,
representation included the Royal College of Anaesthetists
and the Medicines and Healthcare Products Regulatory
Authority (MHRA).
• Australian and New Zealand College of Anaesthetists
(ANZCA) Guidelines on Infection Control in Anaesthesia in
2013.

147. SUMMARY
• Anaesthetic equipment is a potential vector
for transmission of disease.
• We are involved in the care of patients who
harbor potentially pathogenic organisms.
• Hand hygiene, Decontamination, and
Sterilisation of equipment is often overlooked
despite the adequate knowledge of
nosocomial infection.

148. SUMMARY
• Single-use equipment should be utilized
where appropriate.
• Re-usable items must be processed by a
Central Sterile Supplies Department.
• The choice of decontamination method
depends on the infection risk associated with
the item.

149. SUMMARY
• Cleaning is an essential pre-requisite to
equipment decontamination.
• Precautions against the transmission of
infection between patient and anaesthetist or
between patients should be a routine part of
anaesthesia practice.

150. CARRY HOME
• Precautions are recommended for all patient
regardless of their diagnosis or presumed
infectious status and must be implemented
when there is a possibility of contact with:
• 1 Blood.
• 2 All other body fluids.
• 3 Non-intact skin.
• 4 Mucous membranes.

151. ARE WE responsible for transmitting the
infection and hence increasing the
Health Care Associated Infections
(HCAIs)????

154. Thank you