Airway-associated equipment – a guide for use by Ambulance Infection Control Groups.
(This document was tabled and approved by the JRCALC Committee on 4/07/02, having previously been approved by the Working Party at the Royal College of Anaesthetists on 15/04/02).
- The conscientious application of cleaning and disinfection policies are of the utmost importance in the prevention of cross-infection, colonisation/infection of individual patients and staff protection. This principle should apply as much to the pre-hospital environment as to the hospital itself, and ambulance cross-infection policies should reflect in-hospital practice.<
- Local Infection Control Groups will determine appropriate Trust policies. This document is intended solely as a guide to assist in the formulation of such policies.
- Hand disinfection, including washing, still remains the single most effective means of preventing cross-infection. The thoroughness of application is more important than the time spent on washing or the agent used.
- It is now widespread hospital practice to use respiratory filters to reduce risks from cross-infection or equipment contamination, and this practice should extend to ambulance service practice
4.1 Filters should always be single patient use only.
4.2 Filters in hospital (anaesthetic) practice are usually of the HME (heat moisture exchanger) type, but the more simple filter-only device is satisfactory for pre-hospital use.
4.3 Not all filters are equally effective, and the type selected for prehospital use should be determined by the local Control of Infection Group (or equivalent).
- For (anaesthetic) equipment and attachments, national policy is now moving to indicate that these should either be disposable or decontaminated in a central decontamination unit or Sterile Supply Department (CSSD). As most (if not all) Ambulance Services will not have practical access to these facilities, the following alternatives will need to be considered:
5.1 Oxygen masks and tubing, LMAs, nebuliser masks, mouthpieces etc. These are marked disposable/single patient use, and should be discarded after single patient use, or left with patient at hospital.
5.2 Facemask used with Bag/Valve/Mask resuscitator. The facemask is in intimate contact with the patient and should therefore be disposable/single patient use only. Usage estimates in a large service indicate this figure will be on average around 20 masks per vehicle per year. The bag/valve unit should be protected by the interposition of a filter between facemask and valve (see below).
5.3 Bag and valve. A patient filter should always be inserted between the patient mask and the bag assembly. There is as yet no clear guidance on the reuse limit for a bag assembly protected by a filter, and this should be decided by the local Control of Infection Group (or equivalent).
5.4 Entonox mask/mouthpiece. A joint working party from the RCOG and RCA (2000) have recommended that a filter should always be used in conjunction with Entonox analgesic equipment. The mask/mouthpiece should be single patient use only.
5.5 Oral and nasopharyngeal airways, endotracheal tubes. Should be single patient use (disposable).
5.6 Laryngoscope blade. In hospital this should be sent after each case to a Sterile Services Unit for decontamination. In the absence of such a facility (ie ambulance use) they should either be single patient use (a number of such products are now readily available) or used with a blade sheath. The outer surface of the laryngoscope handle should always be wash-wiped between each patient use.
5.7 Magill forceps. Should be single patient use (disposable).
5.8 Suction tubing. Should be disposable/single use. Suction apparatus should be cleaned in accordance with manufacturer’s instructions.
5.9 Bougies/intubating stylets. Should be single patient (disposable) use.
RCA Website 11 June 2002:
A Working Party on Infection and Anaesthesia is considering appropriate guidelines regarding decontamination of anaesthetic equipment for all forms of surgery (which therefore may be considered applicable also to pre-hospital practice), and is due to report in the near future. (Professor G Smith, Vice-President, Royal College of Anaesthetists). See www.rcoa.ac.uk for details and updates.