Introduction

For an anesthesiologist, cleanliness of equipment is as important as anesthetizing the patients. Precautions and appropriate steps must be practiced by every anesthesiologist to prevent the transmission of infection from one patient to another and also to themselves. Sterilization is the process of making an object or equipment free from all the living microorganisms. Disinfection is the process of destroying most of the microorganisms but not spores.

The foremost crucial step in decontamination is cleaning. If the article is not cleaned properly, the process of sterilization and disinfection can also be affected. Blood and body fluids have to be rinsed thoroughly from the surface of the object by presoaking with detergent and water for at least 3 minutes. The chloride ions from normal saline and sodium hypochlorite solutions can cause corrosion to metals. Therefore, metallic devices should not be rinsed with such solutions. Each device’s manufacturer’s instructions with respect to cleaning should be thoroughly followed to prevent damage to the equipment.

The most common method of sterilization used is autoclaving. It utilizes saturated steam under pressure, which increases the boiling point of water. The minimum time used is 15 minutes at 121°C. After sterilization is done, the items must be dried before being removed from the autoclave. Glutaraldehyde has excellent sterilization capability, even in the presence of organic matter. Soaking for 20 to 30 minutes leads to high-level disinfection. Ethylene oxide, being colorless with a sweet odor, is generally used for sterilization of needles.

Sterilization of Individual Items

1. 
   

   Anesthesia carts:

   
   
   
   
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     Cover the top of the cart with a clean sheet at the start of each case.

     
     
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     Clean all the vertical surfaces at the end of the day.

   
   
2. 
   

   Remove all the equipment from the drawers once every month, and clean the drawer with a germicide.

   
   
3. 
   

   Cylinders:

   
   
   
   
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     Before taking into the operation theater, the cylinder has to be washed with water and detergent and wiped with germicide.

   
   
4. 
   

   Anesthesia machines:

   
   
   
   
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     Same as anesthesia cart.

     
     
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     Knobs should be cleaned frequently.

     
     
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     Equipment from the drawers should be frequently removed and disinfected.

   
   
5. 
   

   Breathing tubes:

   
   
   
   
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     Disposable tubes are widely used.

     
     
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     Reusable tubes should be cleaned and sterilized with pasteurization or chemical disinfection after proper cleansing.

   
   
6. 
   

   Face masks:

   
   
   
   
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     Disposable masks have to be used in case of contaminated cases.

     
     
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     After use, masks should be cleaned with rinsing and scrubbing.

     
     
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     Autoclaving, ethylene oxide, or past­eurization can be used.

   
   
7. 
   

   Airways:

   
   
   
   
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     They must be kept in a suitable container after use.

     
     
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     Airways should be rinsed with cold water immediately after use and be placed in a solution of water and detergent.

     
     
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     Pasteurization, ethylene oxide, or liquid chemical sterilization has to be used for airways.

     
     
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     Rubber airways are autoclaved.

   
   
8. 
   

   Rigid laryngoscopes:

   
   
   
   
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     After use, the laryngoscope and the blade have to be placed on a separate surface to prevent contamination.

     
     
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     The handle is wiped with water and detergent; the batteries removed and sterilized with autoclave, plasma, or ethylene oxide.

     
     
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     The blade should be immersed in water with detergent and washed gently with a soft brush, followed by ethylene oxide, plasma, or autoclaved.

   
   
9. 
   

   Flexible endoscope:

   
   
   
   
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     They are fragile structures with the potential to transmit infection among the patients.

     
     
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     The external surface of the scope has to be wiped with a disinfectant in a gentle manner and then to be immersed in an enzymatic detergent solution and allowed for a time of 2 to 5 minutes.

     
     
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     Later on, sterilization with glutaralde­hyde and hydrogen peroxide is done.

   
   
10. 
    

    Supraglottic airway devices:

    
    
    
    
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      Immediately after use, the supraglottic device is washed thoroughly with water and detergent till the visible organic matter is removed.

      
      
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      Autoclaving is the only recommended method of sterilization for laryngeal mask airway (LMA).

    
    
11. 
    

    Resuscitation bags:

    
    
    
    
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      The bag should be disassembled and cleaned if possible after each use.

      
      
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      The most common method of steril­ization is autoclaving or plasma.