Health care workers share the responsibility of preventing the transmission of infectious diseases from person to person. As discussed in Chapter 24, there are multiple pathogens in our working environment that can cause serious illness or death in our patients or coworkers. Anesthesia technicians are on the front lines in the battle against infectious diseases in the operating room. The anesthesia machine and associated equipment are potential vectors in the spread of infection. Improper handling and cleaning of anesthesia apparatus can increase the transmission of pathogens causing postoperative wound infections, respiratory system infections such as pneumonia, or infections that invade the blood stream and the entire body. Both patients and health care workers are at risk. Anesthesia equipment and personnel are in close contact with patients’ blood, mucous membranes (i.e., mouth, nose), and secretions. The Centers for Disease Control and Prevention (CDC) calls these substances potentially infectious materials (PIMs). Blood and secretions create a moist environment for growth and survival of pathogens such as fungi, yeasts, viruses, and bacteria including Streptococcus and Staphylococcus. Each hospital has its own unique infection-control policy; however, this must be in compliance with state and federal regulations. It is the responsibility of the anesthesia technician to become familiar with the policies at his or her institution and to follow these guidelines closely. Web addresses for guidelines and recommendations of the Centers for Disease Control and Prevention (CDC), the National Institute for Occupational Safety and Health (NIOSH), and the World Health Organization (WHO) are provided at the end of the chapter.

In 1939, Dr. Earle Spaulding developed a classification system for medical devices in order to determine disinfection and sterilization requirements for these instruments. Equipment is classified as critical, semicritical, or noncritical. Critical items are those that come into contact with a break in the skin or mucous membranes, or a sterile area of the body. Examples include surgical instruments, needles, and catheters. Sterilization is required for these objects. Semicritical items are those that come into close contact with mucous membranes such as laryngoscope blades, laryngeal mask airways (LMAs), and nasal airways. Semicritical items require disinfection. Noncritical items only come into contact with intact skin such as stethoscopes, blood pressure cuffs, and pulse oximeters. Cleaning and drying is adequate for these items. Of note, noncritical items used to care for patients who are isolated for transmission-based precautions need further disinfection.

According to the CDC, there are several types of chemical disinfectants approved for use in the health care setting such as alcohols, chlorine compounds, hydrogen peroxide, iodophors, glutaraldehyde, peracetic acid, quaternary ammonium compounds, and phenolics. These disinfectants are not all created equally and have different modes of action leading to different microbicidal activity. It is important to carefully read the instructions for use of each disinfectant and to wear personal protective equipment while handling chemicals. Alcohols are used to disinfect external surfaces of equipment such as stethoscopes, ventilators, or blood pressure cuffs and are not used for the sterilization of equipment because they do not have sporicidal action. Chlorine compounds are often used for disinfection of floors and noncritical surfaces. Glutaraldehyde is considered a high-level disinfectant and is used to clean critical surfaces of anesthesia equipment such as transducers, fiberoptic bronchoscopes, and ventilator components. Glutaraldehyde is not generally used on noncritical surfaces because of its toxicity and its cost. Hydrogen peroxide is also used to disinfect equipment such as endoscopes and ventilators. When using this disinfectant, it is important to note the concentration of the product, as hydrogen peroxide is commercially available in several different dilutions. Iodine is commonly used as antiseptic on skin or tissue. Other iodophors can be used for disinfecting medical equipment. Peracetic acid is used in automated machines to chemically sterilize medical instruments; however, this is an expensive process and requires special training for use. Phenolic germicides and quaternary ammonium compounds are used to disinfect noncritical surfaces. They are not appropriate for high-level disinfection.