Recommended Practices for Cleaning and Processing Anesthesia Equipment

AORN Journal, Nov, 1999

The following recommended practices were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were presented as proposed recommended practices for comments by members and others. They are effective Jan 1, 2000.

These recommended practices are intended as achievable recommendations representing what is believed to be optimal level of practice. Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the recommended practices can be implemented.

AORN recognizes the numerous types of settings in which perioperative nurses practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive procedures may be performed.

Purpose: Anesthesia equipment has the potential to be a factor in the transmission of microorganisms. Proper cleaning, disinfection, and/or sterilization of this equipment can reduce the risk of infection to the patient. These recommended practices provide guidelines for the cleaning and processing of anesthesia equipment and instrumentation.

RECOMMENDED PRACTICE I

Reusable anesthesia equipment that comes in contact with mucous membranes, blood, or body fluid is considered semicritical and should be cleaned and then processed by high-level disinfection, pasteurization, or sterilization between each patient use.

Interpretive statement 1:

Reusable items such as laryngeal mask airways (LMAs), masks, breathing circuits, connectors, self-inflating bags, airways, forceps, and laryngoscope blades should be cleaned and then processed by high-level disinfection or sterilization according to AORN's "Recommended practices for high-level disinfection" or "Recommended practices for sterilization in the practice setting."(1) If pasteurization is the chosen disinfection method, manufacturers' instructions for processing should be followed.

Rationale:

Semicritical items require high-level disinfection, pasteurization, or sterilization.(2) Removal of organic material provides optimal conditions for proper exposure of equipment for disinfection/ sterilization.(3) Some pasteurization units have a cleaning phase before the pasteurization process.

RECOMMENDED PRACTICE II

Single-use items (eg, suction catheters, breathing circuits, endotracheal tubes, stylets) should be used once and discarded according to facility policies and procedures and appropriate local, state, and federal regulations. (See AORN's position statement, "Regulated medical waste definition and treatment: A collaborative document.")(4)

Discussion:

Reuse of items designed for single-use creates the potential for residual toxicity from the reprocessing agent used. Safe and effective functioning of an item to be reused is difficult to verify.

RECOMMENDED PRACTICE III

Potential hazards for perioperative personnel associated with handling contaminated anesthesia equipment (eg, exposure to infectious organisms) should be identified and practices should be established to reduce the risk of injury.

Interpretive statement 1:

All personnel involved with cleaning and processing anesthesia equipment should practice according to AORN's "Recommended practices for standard precautions in the perioperative practice setting."(5)

Rationale:

Standard precautions define general measures for infection control.(6)

Interpretive statement 2:

Anesthesia equipment should be processed using methods that reduce the risk of personnel exposure to pathogens and injury.

Rationale:

Manual cleaning methods that minimize splashing, spraying, spattering, and generation of droplets protect personnel from exposure to blood products, body fluids, and cleaning agents.(7)

RECOMMENDED PRACTICE IV

Equipment (eg, anesthesia machine surfaces, blood pressure cuff, carts, monitors) not in contact with mucous membranes, sterile areas of the body, or nonintact skin should be cleaned/decontaminated when contaminated or visibly soiled and at the conclusion of the day.

Interpretive statement 1:

Noncritical items should be cleaned according to established guidelines.

Rationale:

Established guidelines define optimal cleaning measures for infection control.(8)

RECOMMENDED PRACTICE V

Internal components of the anesthesia machine breathing circuit should be cleaned regularly.

Interpretive statement 1:

Absorbers and valves should be cleaned when the soda lime is changed according to manufacturers' written instructions. Particular attention should be given to the valves.

Rationale:

An appropriate and cost-effective schedule for reprocessing has not been established. At the time this document was developed, routine sterilization or high-level disinfection of the internal components of anesthesia machines was considered unnecessary.(9)

Interpretive statement 2: