Anesthesia ventilator sterilization

[Sergio99]

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Our nurses want us to begin sterilizing the internal parts of the anesthesia ventilators weekly or monthly.

I asked people from California, Washington, Arizona, Toronto, and all said that we were not supposed to touch the internal components of the ventilator, that only the factory techs were supposed to do that.

The users' manuals of anesthesia machines recommend disassembly and sterilization of the internal components of the anesthesia ventilators daily or weekly, "according to procedures established by the user institution following the specific instructions provided by the manufacturer of the sterilizing equipment or agent to be used."

I called the manufacturer and asked if they knew of anyone who followed that guideline, and they were reluctant to give me a straight answer. Somehow I sensed an implied message that the answer was no, or at best, that they didn't know if anyone followed that practice.

Does anyone do this cleaning, disinfecting and sterilizing of the internal parts of the ventilator on a daily or weekly basis? Do you know if your institution maintains such a schedule? And if you do, do your in-house people dismantle the ventilators, or the factory technician comes to do it?

 

[fabfive5]

Our nurses want us to begin sterilizing the internal parts of the anesthesia ventilators weekly or monthly.

I asked people from California, Washington, Arizona, Toronto, and all said that we were not supposed to touch the internal components of the ventilator, that only the factory techs were supposed to do that.

The users' manuals of anesthesia machines recommend disassembly and sterilization of the internal components of the anesthesia ventilators daily or weekly, "according to procedures established by the user institution following the specific instructions provided by the manufacturer of the sterilizing equipment or agent to be used."

I called the manufacturer and asked if they knew of anyone who followed that guideline, and they were reluctant to give me a straight answer. Somehow I sensed an implied message that the answer was no, or at best, that they didn't know if anyone followed that practice.

Does anyone do this cleaning, disinfecting and sterilizing of the internal parts of the ventilator on a daily or weekly basis? Do you know if your institution maintains such a schedule? And if you do, does your in-house people dismantle the ventilators, or the factory technician comes to do it?

I know of nowhere that ROUTINELY sterilizes the vents. They will do it after a known TB case or something, but not routinely. With the amount of crap we already have to do we will end up doing one case a day.

 

[Bertelman]

Our nurses want us to begin sterilizing the internal parts of the anesthesia ventilators weekly or monthly.

I would ask your nurses why exactly they want you to do that. The internal mechanics have become increasingly complex. If this is done by someone untrained, you will see some ventilator failures/malfunctions in the near future.

 

[Depakote]

What peer reviewed data do they have to support this change in practice?

 

[geogil]

What peer reviewed data do they have to support this change in practice?

Silly depakote.. I think you have your answer if you consider who is promulgating these changes...

 

[Depakote]

Silly depakote.. I think you have your answer if you consider who is promulgating these changes...

that was my point.

 

[rsgillmd]

Have you had your JCAHO visit yet? I'd bet good money they are afraid of an upcoming visit and are trying to become picky.

I don't know of any place that routinely sterilizes the internal components of a ventilator in the OR, much less an ICU ventilator.

Forget about asking for peer reviewed evidence. They won't be able to provide you with any. Just tell them the filter in your circuits (I'm assuming you have one) protects your patients between cases.

If there was such a danger, we would be inundated with reports of post-op pneumonia. Not happening as far as I know.

 

[Sergio99]

I would ask your nurses why exactly they want you to do that.

They saw the MD Anderson Cancer Center statistics of zero ventilator-associated pneumonia and want to achieve that same goal.

 

[tkim]

They saw the MD Anderson Cancer Center statistics of zero ventilator-associated pneumonia and want to achieve that same goal.

My hospital had 2+ years without VAP. I don't think they routinely sterilized the ventilators.

 

[Ronin2258]

They saw the MD Anderson Cancer Center statistics of zero ventilator-associated pneumonia and want to achieve that same goal.

Ah. So it is reputation envy.

 

[Bertelman]

They saw the MD Anderson Cancer Center statistics of zero ventilator-associated pneumonia and want to achieve that same goal.

1) Then they should focus their efforts on the ICU

2) Try silver-coated ET tubes. I believe there is actual data behind that.

I know how these nurse meetings go. They invite 30 or so senior-level nurses, who have about 1 month of combined clinical experience amongst them in the past year. They develop some problem, then solicit suggestions, figure out which ones are cost-effective, and run with that. I have literally seen a comment board with post-it notes to solve some problem such as intra-op infections, all anonymous of course. It starts with a few reasonable suggestions, then degenerates to a turf war.

And by the way, if you ever wonder why in the world the local CVS still sells those tri-fold poster boards that anyone over 30 once used for Science Fair, it's for nurses. Junior High School kids use Power Point for their reports, yet nurses still use rubber cement to glue construction paper on those damn things. I won't trust anyone who uses a poster board to comunnicate their point.

/rant

 

[jwk]

Filter!

 

[Gimlet]

And by the way, if you ever wonder why in the world the local CVS still sells those tri-fold poster boards that anyone over 30 once used for Science Fair, it's for nurses. Junior High School kids use Power Point for their reports, yet nurses still use rubber cement to glue construction paper on those damn things. I won't trust anyone who uses a poster board to comunnicate their point.

/rant

LOL, I've thought the same thing every time I see one of those. I think their journals should come in giant tri-fold size, too.

 

[cchoukal]

Anyone else here seeing a huge money-making opportunity? How hard would it be to create a device that hooked up to the I/E ports on the anesthesia machine (or ICU vent) and blew vaporized CHG or some other bacteriocidal agent into the vent/machine to get into all the nooks and crannies to disinfect it?

Does it matter that no one has ever demonstrated an infection from not doing this? Heck no! The "ick factor" of a vent that's used on multiple people is so high you could sell this thing without any data.

 

[jwk]

They saw the MD Anderson Cancer Center statistics of zero ventilator-associated pneumonia and want to achieve that same goal.

And did they ask MD Anderson what they do with their anesthesia vents?

 

[jwk]

1)
And by the way, if you ever wonder why in the world the local CVS still sells those tri-fold poster boards that anyone over 30 once used for Science Fair, it's for nurses. Junior High School kids use Power Point for their reports, yet nurses still use rubber cement to glue construction paper on those damn things. I won't trust anyone who uses a poster board to comunnicate their point.

/rant

HAHAHAHAHAHAHA Funniest post I've seen in weeks !!!!!!!!!

 

[periopdoc]

Anyone else here seeing a huge money-making opportunity? How hard would it be to create a device that hooked up to the I/E ports on the anesthesia machine (or ICU vent) and blew vaporized CHG or some other bacteriocidal agent into the vent/machine to get into all the nooks and crannies to disinfect it?

Does it matter that no one has ever demonstrated an infection from not doing this? Heck no! The "ick factor" of a vent that's used on multiple people is so high you could sell this thing without any data.

Until inhaled disinfectant of choice is tied to some random disease by a shady research group funded by the lawyers and some guy on TV starts saying "Have you ever been exposed to inhaled CHG? Do you have fibromyalgia? You could be entitled to compensation. Contact Hewey, Dewey, Cheatem and Howe PC."

Reward for product development in this field is all about product liability. Eliminate the latter if you want to make and retain money.

- pod

 

[Sergio99]

And did they ask MD Anderson what they do with their anesthesia vents?

We are trying to contact them.

I will keep you posted if we find out more about this.

In the meantime, I want to thank all of you for your opinions and advice.

 

[Ronin2258]

Until inhaled disinfectant of choice is tied to some random disease by a shady research group funded by the lawyers and some guy on TV starts saying "Have you ever been exposed to inhaled CHG? Do you have fibromyalgia? You could be entitled to compensation. Contact Hewey, Dewey, Cheatem and Howe PC."

Reward for product development in this field is all about product liability. Eliminate the latter if you want to make and retain money.

- pod

Probably not too far from the truth, 'Pod. CHG is a persistent agent. According to my old scrub tech manuals, it actually penetrates the skin and hangs there as a bacterial static shield. Side effect is a nasty inflammation/irritation in some people, myself included. I had use betadine or the newer alcohol quick scrub on my hands.

I shudder what would happen if it was aerosolized and sent into the lungs. Toxic exposure pneumonitis might beat ventilator associated pneumonia in mortality.

 

[Coastie]

1) Then they should focus their efforts on the ICU

2) Try silver-coated ET tubes. I believe there is actual data behind that.

I know how these nurse meetings go. They invite 30 or so senior-level nurses, who have about 1 month of combined clinical experience amongst them in the past year. They develop some problem, then solicit suggestions, figure out which ones are cost-effective, and run with that. I have literally seen a comment board with post-it notes to solve some problem such as intra-op infections, all anonymous of course. It starts with a few reasonable suggestions, then degenerates to a turf war.

And by the way, if you ever wonder why in the world the local CVS still sells those tri-fold poster boards that anyone over 30 once used for Science Fair, it's for nurses. Junior High School kids use Power Point for their reports, yet nurses still use rubber cement to glue construction paper on those damn things. I won't trust anyone who uses a poster board to comunnicate their point.

/rant

 

[bullard]

From Guidelines for Preventing Health-Care--Associated Pneumonia, 2003

Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm

8. Anesthesia machines and breathing systems or patient circuits

a. Do not routinely sterilize or disinfect the internal machinery of anesthesia equipment (IB) (80).

b. Between uses on different patients, clean reusable components of the breathing system or patient circuit (e.g., tracheal tube or face mask) inspiratory and expiratory breathing tubing, y-piece, reservoir bag, humidifier, and tubing, and then sterilize or subject them to high-level liquid chemical disinfection or pasteurization in accordance with the device manufacturers' instructions for their reprocessing (IB) (24,26).

c. No recommendation can be made about the frequency of routinely cleaning and disinfecting unidirectional valves and carbon dioxide absorber chambers (Unresolved issue) (81).

d. Follow published guidelines or manufacturers' instructions about in-use maintenance, cleaning, and disinfection or sterilization of other components or attachments of the breathing system or patient circuit of anesthesia equipment (IB) (82,83).

e. No recommendation can be made for placing a bacterial filter in the breathing system or patient circuit of anesthesia equipment (Unresolved issue) (4,84--89).

 

[bullard]

Please do us all a favor and tell the nurses (as delicately and politely as possible) to piss off.

 

[urge]

And by the way, if you ever wonder why in the world the local CVS still sells those tri-fold poster boards that anyone over 30 once used for Science Fair, it's for nurses. Junior High School kids use Power Point for their reports, yet nurses still use rubber cement to glue construction paper on those damn things. I won't trust anyone who uses a poster board to comunnicate their point.

I recently went to one of such meeting and.... yes indeed... the tri fold poster board made an appearance. Must be in their dna.