INFECTION CONTROL NEWSLETTER

Proper cleaning and sterilization or disinfection of reusable equipment are important components of the IC program to reduce infections associated with respiratory therapy and anesthesia equipment. Many devices or parts of devices used on the respiratory tract have been categorized as semicritical in the Spaulding classification system for appropriate sterilization or disinfection of medical devices because they come into direct or indirect contact with mucous membranes but do not ordinarily penetrate body surfaces, and the associated risk for infection in patients after the use of such devices is less than that associated with devices that penetrate normally sterile tissues. Thus, if sterilization of these devices by steam autoclave or ethylene oxide is not possible, they can be subjected to high-level disinfection by pasteurization at 75 C for 30 minutes or by use of liquid chemical disinfectants.

If a respiratory device needs rinsing to remove a residual liquid chemical sterilant/ disinfectant after chemical disinfection, sterile water is preferred because tap or locally prepared distilled water might contain microorganisms that can cause pneumonia.

The internal machinery of mechanical ventilators used for respiratory therapy is not considered an important source of bacterial contamination. Thus, routine sterilization or high-level disinfection of the internal machinery is considered unnecessary. Using high-efficiency bacterial filters at various positions in the ventilator breathing circuit has been advocated . Most facilities use ventilators with either bubble-through or wick humidifiers that produce either insignificant or no aerosols, respectively, for humidification. Thus, these devices probably do not pose an important risk for pneumonia in patients. In addition, bubble-through humidifiers are usually heated to temperatures that reduce or eliminate bacterial pathogens. Sterile water, however, is still usually used to fill these humidifiers because tap or distilled water might contain microorganisms, such as Legionella sp., that are more heat-resistant than other bacteria.

Twelve CDC recommendations

1. Do not routinely change circuts more frequently than every 48 hours the breathing circuit, including tubing and exhalation valve, and the attached bubbling or wick humidifier of a ventilator that is being used on an individual resident.
2. No Recommendation for the maximum length of time after which the breathing circuit and the attached bubbling or wick humidifier of a ventilator being used on a resident should be changed.
3. Sterilize reusable breathing circuits and bubbling or wick humidifiers or subject them to high-level disinfection between their uses on different residents.
4. Periodically drain and discard any condensate that collects in the tubing of a mechanical ventilator, taking precautions not to allow condensate to drain toward the patient. Wash hands after performing the procedure or handling the fluid.
5. Wear gloves for handling respiratory secretions or objects contaminated with respiratory secretions of any resident.
6. Change gloves and wash hands a) after contact with a resident; b) after handling respiratory secretions or objects contaminated with secretions from one resident and before contact with another resident, object, or environmental surface; and c) between contacts with a contaminated body site and the respiratory tract of, or respiratory device on, the same resident.
7. Wear a gown and face shield if soiling with respiratory secretions from a resident is anticipated, and change the equipment after such contact and before providing care to another resident.
8. When changing a tracheostomy tube, use aseptic techniques and replace the tube with one that has undergone sterilization or high-level disinfection.
9. No Recommendation for wearing sterile gloves rather than clean but nonsterile gloves when suctioning a patientıs respiratory secretions.
10. If the open-suction system is employed, use a sterile single-use catheter.
11. Use only sterile fluid to remove secretions from the suction catheter if the catheter is to be used for re-entry into the resident's lower respiratory tract
12. No Recommendation for preferential use of the multiuse closed-system suction catheter or the single-use open-system catheter for prevention of pneumonia.

Modification of urinary tract infection definition

Urinary Tract Infection
Symptomatic with or without a catheter
NOTE: Asymptomatic bacteriuria (positive urine culture alone) is not included.

Resident must have one of the following:
Chills; Fever > 100 F; New or increased incontinence; Urgency; Frequency, Dysuria; Suprapubic pain/flank pain or tenderness; Change in mental status or ADL

AND

Urine culture > 10,000 colonies/mL with no more than two species; OR positive laboartory test for nitrite, WBC or RBC