The importance of effectively cleaning and disinfecting ventilators is obvious : Ventilator components can become contaminated by exhaled gases and , potentially , by airway excretions . Unfortunately , the reprocessing instructions provided by ventilator manufacturers are , in some cases , incomplete or confusing ; and even guidance from regulatory authorities is not always clear .”
internal exhalation valves or other reusable ventilator components that do not directly contact such biologic material ? The available guidance is not always clear . In ECRI ’ s view , because these ventilator components can come into contact with--and thus can be contaminated by--exhaled patient gas and airway secretions , they should be disinfected ( or sterilized ) between patients .”
According to ECRI ( 2023 ), factors triggering confusion include whether internal exhalation valves or other reusable ventilator components that contact exhaled patient gas require high-level disinfection ( or sterilization ) between patients . ECRI says it believes they do . Additionally , there is confusion around whether use of a filter in the breathing circuit is sufficient to prevent contamination of ventilator components . ECRI says it believes it is not , noting , “ The primary purpose of the filter is to limit the spread of pathogens through the atmosphere , not to protect ventilator components from contamination .”
The CDC states in its 2008 Guideline for Disinfection and Sterilization in Healthcare Facilities to “ Provide , at a minimum , high-level disinfection for semi-critical patient-care equipment ( e . g ., gastrointestinal endoscopes , endotracheal tubes , anesthesia breathing circuits , and respiratory therapy equipment ) that touches either mucous membranes or nonintact skin .” However , as ECRI ( 2021 ) points out , “ It is not completely clear which ventilator components , if any , are covered by this recommendation . While the endotracheal tube clearly touches mucous membranes , the ventilator components do not touch them directly . On the other hand , airway secretions ( and ventilator condensate , which contains secretions ) are a possible vector by which the patient ’ s mucous membranes could contaminate ventilator components .”
Confusion can persist if healthcare facilities use a fleet of ventilators from different manufacturers , all with different instructions for use ( IFUs ).
In a 2021 report , Safe Cleaning and Disinfection of Ventilators : ECRI ’ s Recommendations , ECRI acknowledges that “ Some vendors provide detailed cleaning and disinfecting information but make no specific recommendations on how often these tasks should be performed . And some vendors informally instruct clients that a filter in the breathing circuit , either at the patient wye or between the circuit and the exhalation valve , will be sufficient to prevent pathogens from finding their way onto reusable components and