Cleaning and disinfection of ventilator tubes

Cleaning and disinfection of ventilator tubes
Cleaning and disinfection method selection
At present, the main methods used by domestic hospitals to clean and disinfect ventilator pipelines include chemical disinfectant disinfection, mechanical cleaning and thermal disinfection, and ethylene oxide sterilization. Mechanical cleaning and thermal disinfection are preferred.

1. Chemical disinfectant soaking method
①Chlorine-containing disinfectant
②Glutaraldehyde sterilizer
③Peracetic acid disinfectant
④Acidic oxidation potential water (high redox potential water). The advantage of acidic oxidation potential water is that soaked items do not need to be rinsed again, because the acidic oxidation potential water remaining on the items has been reduced to water during the drying process.

2. Thermal mechanical cleaning and disinfection method
The advantage is that centralized cleaning and disinfection has unified cleaning and disinfection process standards, which can greatly improve work efficiency and cleaning and disinfection quality, facilitate management and quality inspection, and can also reduce environmental pollution.

3. Gas fumigation method: ethylene oxide sterilization method
It is mainly used to disinfect pipelines used by patients with severe infections. The advantage is that it has a thorough broad-spectrum sterilization effect, strong penetration, and is non-corrosive, but it is flammable, explosive, highly toxic, has residues, and is expensive.

Application of manual and mechanical cleaning and disinfection methods
1.Artificial method
The main methods include drug or oxidation potential water immersion method, gas sterilization method, and radiation irradiation method (generally not used in clinical practice now). Soaking and disinfecting with drug solution is currently the most common method. You can first flush away the dirt in the pipeline with clean water. Blood stains or phlegm scab and other stolen goods in the pipeline need to be soaked in a special sink with enzyme-containing liquid, and then use a special Clean thoroughly with a brush, and then soak all the cleaned pipelines and accessories in effective disinfectant. There should be no dead bends in the pipelines, and there should be no air bubbles left in the hollow object cavity. The commonly used disinfection method is 1000 mg/L Soak in effective chlorine disinfectant for 30 minutes, rinse with sterile distilled water, dry and put into a clean bag, dry and store for later use.

2. Mechanical cleaning and thermal disinfection method
Items such as ventilator tubes and humidification tanks, which indirectly come into contact with the patient's mucous membrane, are moderately hazardous medical equipment and require high-level disinfection before use. According to WS 310.2-2009 Hospital Disinfection Supply Center Part 2: Technical Operation Specifications for Cleaning, Disinfection and Sterilization: For diagnostic and treatment instruments, utensils and items used directly after disinfection, the moist heat disinfection temperature should be ≥90℃, the time should be ≥5min, or the AO value ≥3000.

(1) Fully automatic cleaning and disinfection machine: It is recommended to be the first choice for hospitals with qualified conditions. Through the pre-set standard procedures, the cleaning, disinfection, rinsing and drying of pipelines and other items are completed at one time. After the procedure is completed, the cleaning and drying effects are checked, packaged and reserved. The validity period is 7 days.
(2) Except for special circumstances, follow the workflow of cleaning first and then disinfecting.
(3) It is recommended to use disposable items for ventilator tubes used by infected patients (including Mycobacterium tuberculosis, AIDS virus, hepatitis B virus, MRSA, MRSE and other drug-resistant bacterial infections); if they are reused, they should be cleaned separately. disinfect.
(4) Ventilator tubes and humidification bottles used by patients with suspected prion infection, gas gangrene infection, and sudden infectious diseases of unknown origin should be disposable items and be incinerated in double-sealed packages after use. Reused ventilator tubes, humidification bottles and other items should be handled in accordance with WS 310.2-2009 Hospital Disinfection Supply Center Part 2: Technical Operation Specifications for Cleaning, Disinfection and Sterilization.

Quality monitoring of cleaning and disinfection effects
The cleaning and disinfection process of the ventilator should first comply with the national hospital infection requirements. The hospital's infectious disease department, disinfection supply center, and use department jointly form a quality control team to regularly sample and analyze the disinfection of the ventilator, and register it in detail. Continuously optimize processes and methods to achieve good results of continuous improvement.
1. Chemical immersion disinfection method: Monitor the concentration of disinfectant and disinfection time every day and keep records to ensure the disinfection effect.
2. Mechanical thermal disinfection method: Parameters such as temperature, time or A0 value of disinfection should be monitored and recorded, and kept for inspection.
3. Disinfected pipelines, humidification tanks and other items should be monitored once a quarter, and monitoring records should be kept.
Sampling method: Object surface sampling method.
Sampling time: after items are disinfected.
Sampling items: ventilator pipelines and humidification tanks, etc.
Monitoring method: Count the number of bacterial colonies and isolate and identify pathogenic microorganisms if necessary.
Testing standard: The total number of colonies of moderately dangerous medical equipment is ≤20cfu/piece. If there is a high suspicion of hospital infection outbreaks or ventilator-related infections, timely monitoring should be carried out.
4. The cleaning effect of the cleaning and disinfecting machine should be monitored every year.

Cleaning and disinfection of ventilator accessories
1. For the air source filter, first remove the filter, rinse the surface dust with clean water, shake it dry or dry it before installing it. Routine disinfection is not required, and it is generally cleaned once a day or every other day.
2. Flow sensor: It is very precise. After use, it is usually soaked in 75% alcohol for 15 minutes for disinfection, and then dried naturally before use. Do not rinse with water or shake it hard.
3. Exhalation valve: Open the exhalation valve, clean it thoroughly with water, and send ethylene oxide for disinfection. Soak the exhalation valve diaphragm (metal sheet) in 75% alcohol for 12 hours and then dry it for later use. Routinely replace it once a week, and replace it immediately after use for infected patients.
4. Simulated lungs: wipe with 75% alcohol.
5. Simple respirator: dedicated to each patient. After use, soak the ball and safety valve in chlorine-containing disinfectant for 30 minutes, rinse thoroughly with water, and dry them. The duckbill valve is soaked in 75% alcohol for 30 minutes and then wiped dry. Reconnect the simple respirator and package it to deliver ethylene oxide.
6. Temperature sensor: At the pipeline interface, wipe the interface with 75% alcohol before installing the pipeline.
7. The bacterial filter inside the ventilator: Replace it once a year.
8. Breathing filter: Disinfect with ethylene oxide after use and keep dry.