Endotracheal Tubes - Clean, Disinfect and Store

Endotracheal Tubes - How to clean, disinfect and store this device.

Any examples included in this response are for illustrative purposes only.

Devices such as endotracheal tubes (ETT's) may be exposed to potentially infectious material during indicated use, and can become contaminated through direct contact with the patient's skin, mucous membranes, secretions and blood. An ETT interferes with normal patient defenses allowing pathogens direct access to the lung. To reduce the risk of infection, the importance of standardizing the process of reprocessing as indicated, with a minimum high level disinfection (IC.02.02.01 EP 2) or sterilization (if a single use device is not used and manufacturer's instructions for use is adhered to), and storage is emphasized.

Cleaning and Disinfecting:
ETT's are most commonly obtained as sterile single use devices. As defined, single use devices are intended for one time use, on a single patient, during a single procedure. If an ETT or Laryngeal Mask Airway (LMA) is not designed by the manufacturer as a single use device, it is considered a semi-critical item and therefore would require using the process for disinfection and sterilization of semi-critical items as designated by the CDC as "high-level" disinfection. Please refer to the CDC and HICPAC document entitled Guidelines for Disinfection and Sterilization in Healthcare Facilities, 2008.In addition, the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) states ETT's are "semi critical" items. Please refer to the CDC and HICPAC's document entitled Guidelines for Preventing Healthcare-Associated Pneumonia, 2003.The last page of the guideline lists ETT's as semi critical items.

Recommendation IIIA1b states how semi critical items must be processed and packaged:
"Whenever possible, use steam sterilization (by autoclaving) or high-level disinfection by wet heat pasteurization at >158oF (>70oC) for 30 minutes for reprocessing semi critical equipment or devices (i.e., items that come into direct or indirect contact with mucous membranes of the lower respiratory tract) that are not sensitive to heat and moisture (see examples in Appendix). Use low-temperature sterilization methods (as approved by the Office of Device Evaluation, Center for Devices and Radiologic Health, FDA) for equipment or devices that are heat- or moisture-sensitive (307;309;310;314;315). After disinfection, proceed with appropriate rinsing, drying, and packaging, taking care not to contaminate the disinfected items in the process (308;310). CATEGORY IA"

Storage (IC.02.02.01 EP 4):
ETT's should be kept free from contamination until the time of use. Once opened, there is potential for microorganisms to settle on the device the longer it remains open and unused. Increased handling of the opened unused device increases the chances of contamination. Ensure that the storage area provides protection from dust, moisture, temperature and humidity extremes. Refer to the CDC and HICPAC document entitled Guidelines for Disinfection and Sterilization in Healthcare Facilities, 2008.

Pre-opening of Endotracheal tubes (ETT):
Currently available evidence-based guidelines do not include recommendations for or against the pre-opening of ETT's prior to use for any length of time. Related scientific articles to date that address pre-opening ETT's and the risk of contamination with potentially harmful organisms while left opened for days, are limited. Until evidence exists that is supported by well-designed clinical studies, an organization may: conduct a risk assessment, and refer to appropriate professional organizations that address this issue in their position statements, weigh the risk versus the benefits of having pre-opened ETT's given the absence of firm evidence that pre-opened ETT's are advantageous or best practice, utilize a consistent process throughout their organization based on expert clinical consensus that is documented in policy and procedure.

Joint Commission surveyors will evaluate processes related to ETT's to ensure that they are safe for patient use. They will check that ETT's are:
  • A single use device, or if not a single use device, are processed via either high-level disinfection or sterilization, according to manufacturer's instructions for use (IFU's).
  • Packaged as a sterile single use device. If the ETT is not a single use device, CDC and HICPAC guidelines do not specify one method in which ETT's should be packaged. An example of an acceptable packaging method would be a peel pack post steam sterilization.
  • Stored in a way that would prevent recontamination. Examples of noncompliant storage would include unwrapped or opened ETT's in an anesthesia drawer, as well as unwrapped or opened ETT's on top of or within a code cart.
  • If the organization pre-opens ETT's (refer to the above section on pre-opening of ETT's) a consistent process is demonstrated and is reflected by policy and procedure.
Last updated on November 22, 2019
Manual: Critical Access Hospital
Chapter: Infection Prevention and Control IC

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