Bacterial and viral contamination of breathing circuits after extended use – an aspect of patient safety?

Dubler, Simon; Zimmermann, Sabine; Fischer, Marc; Schnitzler, Paul; Brückner, Thomas; Weigand, Markus A.; Frank, Uwe; Hofer, Stefan; Heininger, Alexandra

doi:10.1111/aas.12768

Cited by 29 publications

(26 citation statements)

References 38 publications

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“… 95 Two studies have indicated that it is as safe from a microbiological standpoint to reuse circuits, and to change and wash them weekly compared with daily. 96 , 97 Several studies in the USA, including laryngoscope handles and blades, 84 LMAs, 72 and blood pressure cuffs 75 found significant cost and environmental savings from reusable devices compared with disposables.…”

Section: Life Cycle Assessments In Anaesthesia and Critical Carementioning

confidence: 99%

Environmental sustainability in anaesthesia and critical care

McGain

Muret

Lawson

et al. 2020

British Journal of Anaesthesia

235

226

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The detrimental health effects of climate change continue to increase. Although health systems respond to this disease burden, healthcare itself pollutes the atmosphere, land, and waterways. We surveyed the 'state of the art' environmental sustainability research in anaesthesia and critical care, addressing why it matters, what is known, and ideas for future work. Focus is placed upon the atmospheric chemistry of the anaesthetic gases, recent work clarifying their relative global warming potentials, and progress in waste anaesthetic gas treatment. Life cycle assessment (LCA; i.e. 'cradle to grave' analysis) is introduced as the definitive method used to compare and contrast ecological footprints of products, processes, and systems. The number of LCAs within medicine has gone from rare to an established body of knowledge in the past decade that can inform doctors of the relative ecological merits of different techniques. LCAs with practical outcomes are explored, such as the carbon footprint of reusable vs single-use anaesthetic devices (e.g. drug trays, laryngoscope blades, and handles), and the carbon footprint of treating an ICU patient with septic shock. Avoid, reduce, reuse, recycle, and reprocess are then explored. Moving beyond routine clinical care, the vital influences that the source of energy (renewables vs fossil fuels) and energy efficiency have in healthcare's ecological footprint are highlighted. Discussion of the integral roles of research translation, education, and advocacy in driving the perioperative and critical care environmental sustainability agenda completes this review.

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Section: Life Cycle Assessments In Anaesthesia and Critical Carementioning

confidence: 99%

Environmental sustainability in anaesthesia and critical care

McGain

Muret

Lawson

et al. 2020

British Journal of Anaesthesia

235

226

View full text Add to dashboard Cite

show abstract

“…Because high-flow oxygen therapy entails a continuous unidirectional gas flow, we anticipated that contamination in high-flow oxygen therapy circuits would occur less frequently than in anesthetic circuits, where, depending on sampling techniques, the rate of contamination has been found to be from 3.3% to 54%. [19][20][21] Analysis of our findings indicated that the contamination rate for high-flow oxygen therapy circuits may be as high as for anesthetic breathing circuits.…”

Section: Discussionmentioning

confidence: 85%

“…This result was consistent with previous comparisons of 1-d and 7-d use of anesthetic circuits. [19][20][21] Our study had several limitations. First, because none of the subjects showed any symptoms of hospital-acquired pneumonia, the clinical impact was unclear: contamination of high-flow oxygen therapy circuits does not necessarily lead to hospital-acquired pneumonia.…”

Section: Discussionmentioning

confidence: 95%

Bacterial Contamination of Circuit Inner Surfaces After High-Flow Oxygen Therapy

et al. 2019

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BACKGROUND: During high-flow oxygen therapy, heated humidified gas is delivered at high flow. Although the warmth and humidity of this gas facilitates mucociliary function in the lower airway, warm and humid conditions also promote bacterial growth. Bacterial contamination of high-flow oxygen therapy circuits has not been well investigated. We examined the incidence of bacterial contamination in high-flow oxygen therapy circuits. METHODS: This was a prospective observational study in a university hospital 10-bed general ICU. After final high-flow oxygen therapy discontinuation, samples were obtained from the interface and the chamber ends of the circuit. Initially, a half circumference of each inner surface was swabbed, after which the whole circuit was left in the ICU at room temperature for 6 h. The samples were then, in the same way, taken from the previously unswabbed arcs of the end inner surfaces. All the samples were sent to a biology laboratory and cultured. RESULTS: In all, 118 samples were collected from 31 circuits. The median duration of high-flow oxygen therapy was 48 h (interquartile range, 26-96 h). Of 31 circuits, contamination occurred in 5 circuits (16.1% [95% CI 5.5-33.7%]). CONCLUSIONS: Bacterial contamination of inner surfaces of the circuit after high-flow oxygen therapy was relatively high.

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“…Both antibacterial filters and viral filters are available that could be connected to the circuit. 16 A complete updated description regarding PPE, its proper use and disposal is available at the CDC web site. 6,9 Amniotic Fluid and Meconium Staining…”

Section: Equipmentmentioning

confidence: 99%

“…Both antibacterial filters and viral filters are available that could be connected to the circuit. 16 …”

Section: Approach To Birth Resuscitation and Postnatal Carementioning

confidence: 99%

Neonatal Resuscitation and Postresuscitation Care of Infants Born to Mothers with Suspected or Confirmed SARS-CoV-2 Infection

et al. 2020

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The first case of novel coronavirus disease of 2019 caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) was reported in November2019. The rapid progression to a global pandemic of COVID-19 has had profound medical, social, and economic consequences. Pregnant women and newborns represent a vulnerable population. However, the precise impact of this novel virus on the fetus and neonate remains uncertain. Appropriate protection of health care workers and newly born infants during and after delivery by a COVID-19 mother is essential. There is some disagreement among expert organizations on an optimal approach based on resource availability, surge volume, and potential risk of transmission. The manuscript outlines the precautions and steps to be taken before, during, and after resuscitation of a newborn born to a COVID-19 mother, including three optional variations of current standards involving shared-decision making with parents for perinatal management, resuscitation of the newborn, disposition, nutrition, and postdischarge care. The availability of resources may also drive the application of these guidelines. More evidence and research are needed to assess the risk of vertical and horizontal transmission of SARS-CoV-2 and its impact on fetal and neonatal outcomes. Key Points• The risk of vertical transmission is unclear; transmission from family members/providers to neonates is possible.• Optimal personal-protective-equipment (airborne vs. droplet/contact precautions) for providers is crucial to prevent transmission. • Parents should be engaged in shared decision-making with options for rooming in, skin-to-skin contact, and breastfeeding.

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Bacterial and viral contamination of breathing circuits after extended use – an aspect of patient safety?

Cited by 29 publications

References 38 publications

Environmental sustainability in anaesthesia and critical care

Environmental sustainability in anaesthesia and critical care

Bacterial Contamination of Circuit Inner Surfaces After High-Flow Oxygen Therapy

Neonatal Resuscitation and Postresuscitation Care of Infants Born to Mothers with Suspected or Confirmed SARS-CoV-2 Infection

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