Guidelines on Infection Control in Anaesthesia
Definitions:
- Asepsis
Prevention of microbial contamination of living tissues or sterile materials. - Disinfection
Inactivation of non-sporing organisms with thermal or chemical means. - Sterilisation
Complete destruction of all microorganisms, including spores.
Equipment classifications:
- Critical
Penetrate skin or mucous membranes, or enters a sterile space. Requires sterilisation. - Semi-critical
In contact with intact mucous membranes or becomes contaminated with readily transmissible organisms. Requires sterilisation or high level disinfection. - Non-critical
Contacts skin or does not contact the patient. Requires a low-level of disinfection or cleaning.
Infection Prevention
Precautions:
- Standard precautions
Gloves, eyewear, gowns, or aprons. - Gloves
- When anticipated contact with body fluids
- Changed after moving from a contaminated to a non-contaminated body site
- Masks
When performing a sterile procedure under full aseptic conditions. - Overshoes
- Not required if theatre shoes in use
- Should be worn if shoes are contaminated
- Hand hygiene should be performed after removing them
Behaviours:
- Hand hygiene
- Theatre traffic
Should be minimised, and theatre doors should be closed. - Sharps
Should be:- Disposed of immediately after use
- Not re-sheathed, bent, broken, or manipulated
Active management:
- Antibiotics
- Maintain normothermia
- Restrictive transfusion strategy
- Vaccinations
Anaesthetic Equipment
Airway equipment:
- Masks
Semi-critical. - Laryngoscopes
Critical, require sterilisation. - Bronchoscopes
Semi-critical. - Bougies
Single-use preferred.
Anaesthetic breathing systems:
- Circuits
Can be used for multiple cases provided an HME is in place. - Breathing bag
Cleaned between each use. - Sampling lines
- Gas should pass through a viral filter
- Can be reused
- Surfaces and monitors
Cleaned with detergent and water between patients.
Ultrasound:
- Surface probes
- Removal of gel and debris
- Wiped with detergent cloth
- Disinfected
- Internal probes
Semi-critical.
Invasive Procedures
Require aseptic technique:
- Cannulation
- Hand hygeine
- Gloves
- Skin disinfectant
Alcohol only suitable for cannulation ⩽24 hours.
- Central venous cannulation
- Aseptic technique
- Maximal barrier precautions
- Full body draping
- Hat, mask, gown, sterile gloves
- 0.5-2% chlorhexidine skin preparation
Tincture of iodine, or 70% alcohol are appropriate if chlorhexidine is contraindicated.
Drugs
Contamination can be minimised by:
- Using one ampoule only for one patient
- Using filter needs when appropriate
- Wiping rubber stopper of vial with disinfectant prior to aspirating contents