What is the proper protocol for sterilizing a ventilator between two patients in an Intensive Care Unit (ICU) setting?

Ventilator Sterilization Between Patients

Do not routinely sterilize or disinfect the internal machinery of mechanical ventilators between patients; instead, sterilize or subject to high-level disinfection only the reusable breathing circuit components (tubing, humidifiers, reservoir bags, y-pieces, masks) that come into contact with the patient. 1

Internal Ventilator Machinery

• The internal machinery of mechanical ventilators does not require routine sterilization or disinfection between different patients. 1, 2
• This recommendation applies specifically to the internal mechanical and electronic components that do not contact the patient or respiratory secretions. 1

Breathing Circuit Components Requiring Sterilization or High-Level Disinfection

Between uses on different patients, the following reusable components must be cleaned first, then either sterilized or subjected to high-level liquid chemical disinfection or pasteurization: 1, 2

• Inspiratory and expiratory breathing tubing 1
• Y-piece 1
• Reservoir bag 1
• Humidifier and associated tubing 1
• Tracheal tube or face mask 1
• Exhalation valve 1

Follow the device manufacturer's instructions for reprocessing methods, including appropriate temperatures, chemical concentrations, and contact times. 1, 2

Critical Processing Steps

Cleaning must always precede high-level disinfection or sterilization, as organic material prevents effective microbial elimination. 2

After chemical disinfection, rinse reusable semicritical respiratory equipment with sterile water (not distilled or tap water). 1

Follow rinsing with thorough drying and appropriate packaging to prevent recontamination. 1

Accessory Equipment Requiring Sterilization or High-Level Disinfection

Between uses on different patients, sterilize or subject to high-level disinfection: 1, 2

• Portable respirometers 1, 2
• Ventilator thermometers 1, 2
• Reusable hand-powered resuscitation bags 1

Heat-Moisture Exchangers (HME) and Filters

Replace the entire ventilator circuit (including HME and bacterial/viral filters) with new equipment for each patient. 1

Single-use items such as HMEs, bacterial/viral filters, and disposable circuits should not be reprocessed or reused between patients. 1, 2

Humidifier Management

For bubbling or wick humidifiers that will be reused, sterilize or subject to high-level disinfection between patients. 1

Use sterile water to fill bubbling humidifiers. 1, 3

Change oxygen humidifier tubing (including nasal prongs or masks) between different patients. 1, 3

Common Pitfalls to Avoid

Do not skip the cleaning step before disinfection or sterilization, as this is the most common cause of inadequate decontamination. 2

Do not base processing decisions on whether the patient had a known infection; use the same sterilization standards for all patients regardless of diagnosis. 2

Do not reprocess equipment labeled by manufacturers as single-use unless specific data demonstrate safety, cost-effectiveness, and maintained structural integrity. 1

Do not use tap water or distilled nonsterile water for rinsing after chemical disinfection; only sterile water is acceptable. 1

Do not place bacterial filters between the humidifier reservoir and inspiratory tubing, as this does not provide additional benefit. 1