Three Steps

Cleaning airway equipment prior to reuse involves three steps:

It is very important to perform all three steps to make equipment safe for future patients and for the staff that handle the equipment.

Equipment is easier to clean if blood/sputum is not allowed to dry, so wipe equipment such as a laryngoscope blade after use with wet gauze or soak it in water before decontaminating it.

Step 1: Decontamination

To kill the most harmful bacteria and viruses

This process kills bacteria and viruses including Hepatitis B, Hepatitis C and HIV.

The purpose of this step is to make the equipment safer when handled, by reducing the risk of infection to the person cleaning it.

Decontamination technique:

Put equipment in a bucket full of 0.5% chlorine solution (sodium hypochlorite 'bleach') for 10 minutes: This is the cheapest and most rapid decontaminant. It can be used on most equipment but rubber and metal should not soak for over 20 minutes otherwise they will discolour or rust

Alternatives are:

  • 70% ethyl or isopropyl alcohol: It has similar uses to chlorine
  • 0.5–3% phenolic compounds: these discolour plastic and rubber, so are used for metals, such as laryngoscopes

Step 2: Cleaning

To remove dirt

Cleaning is a process to remove visible dirt including dust, soil, blood or other body fluids. It also removes up to 80% of bacteria and viruses.

Proper cleaning is vital otherwise disinfection or sterilization will be much less effective.

Cleaning technique: Either of the following:

Automatic cleaning
  • Examples are: Ultrasonic cleaner and washer-sterilizer
  • Effective
  • May not be available due to expense

Manual cleaning

  • Use soapy water and a brush until the equipment looks clean, especially the small parts. Repeat if it is still dirty
  • Water temperature should be below 45oC (113sup>oF) to stop blood clotting
  • When it is clean, rinse with clean water and air dry

Step 3: Disinfection

This eliminates 95% of microorganisms, all except some bacterial spores, such as Clostridium, as they have a thick cell wall

Is that good enough?

This is adequate for most airway equipment as it will usually only be touching mucous membranes or broken skin, but not entering normally sterile tissues.

Disinfection technique: Options include:

  • Steaming for 20 minutes (cheaper than boiling as less water used)
  • Boiling should be at 100oC for 20 minutes (longer at altitude)
  • Chemical for example immersing in: 2% glutaraldehyde for 20 minutes (takes 60 minutes to kill TB)
    • 0.3% bicarbonate must be added to activate it
    • It is irritating to the skin so items must be rinsed three times in sterile water and left to dry after using glutaraldehyde

Step 3: Sterilization

To eliminate all germs including spores

This eliminates 100% of microorganisms including bacterial spores

Spores do not cause respiratory infection, so this is not usually necessary for airway equipment (even though many items can be sterilised). It is necessary for equipment which penetrates through normally sterile tissue, such as kits for needle cricothyroidotomy and surgical cricothyroidotomy.

Sterilization technique:

  • Autoclave: package items after cleaning and drying but before sterilising. Then put in high-pressure steam at 134 ° C for 3 minutes or 121 ° C for 15 minutes. This can’t be used for some plastics
  • Dry heat/oven (160oC for 2 hours)
  • Chemical - Ethylene oxide - expensive
  • Radiation - expensive

Two different types of autoclave