recommendations for reducing risks of infection associated with suction collection procedures
TRANSCRIPT
Recommendations for reducing risks ofinfection associated with suctioncollection procedures
Gina Pugliese, R.N., M.S.N.Don C. Mackel, M.S., M.P.H.G. F. Mallison, M.P.H.Chicago, III., and Atlanta, Ga.
It is recognized that risks are incurred when health care workers contact variousbody fluids. The handling of suction collection equipment poses a risk because it isone way workers may come in contact with these fluids. Minimizing the risksassociated with suction procedures can be accomplished if appropriate policies andprocedures can be developed in health care facilities. (AM J INFECT CONTROL 8:72,1980.)
Procedures for aspiration and suction havebeen discussed in scientific and technical literature for decades.v " The purpose of this articleis to discuss the risks to patients and staff associated with the suctioning of body fluids, including those containing blood and mucus.Recommendations are made regarding appropriate techniques to reduce risks.
RISKS OF INFECTION
Several investigations have suggested thathealth care workers, especially those having direct contact with material aspirated from therespiratory tract, have a risk of acquiringherpes virus from patients with occult infections.ll-
14 One investigator determined that onethird of attending nurses who were antibodynegative developed skin lesions at some pointduring the study period.!'
Operating room personnel, including surgeons, have been shown to have an increased
From the Augustana Hospital and Health Care Center and theEpidemiologic Investigations Laboratory Branch, BacterialDiseases Division, and Bureau of Epidemiology Center ForDisease Control, Public Health Service, Department of Health,Education and Welfare, Atlanta.
Reprint requests: Gina Pugliese, RH, M.SN., Nurse Epidemiologist, Augustana Hospital and Health Care Center, 411 WestDickens. Chicago, IL 60614.
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risk of acquiring hepatitis B by virtue of theirclose contact with blood of HBsAg-positive patients." Contact with the blood of such patientsis likely associated with blood suctioning andhandling of aspirated blood during cleaningprocedures. Because a small percentage of persons with acute cases of hepatitis B will remainserologically positive indefinitely. there may bea continually rising number of patients withHBsAg-positive blood being operated on without hospital personnel being aware of the potential risk." In one study, the seropositivity forhepatitis B was statistically associated withhistories of getting blood on skin and clothes atwork, but not with histories of accidental needle sticks or cuts on the hands or with failing towash hands or wear gloves."
Surgical procedures most often associatedwith infections include those where implants orhigh-flow suction is used." Suction fluid is discarded after most surgical procedures. However, in coronary bypass procedures, there areadditional suction lines to return aspiratedblood from the wound to a preoperative oxygenator and recirculate it to the patient. Whenthis line is not aspirating blood, it is aspiratingroom air (approximately 1.5 to 2.0 cubic feet!minute), which mixes with the blood in themachine and eventually is recirculated to the
Volume 8 Number 3
August. 1980 Reducing infections [rom suc tion collection procedures 73
patient, possibly increasing risk of patientinfection.
Historically, onl y direct contact with the aspirated liquids has been a matter of concern,but investigators ha ve a lso shown that suctionpumps, traps , and coll ection vessels can createae rosols. ' : 18. 19 In on e s tudy, equipment-dispersed mists in a hospi tal were shown to travelup to 130 feet in 30 minutes." If such aerosols orsprays of potentially hazardous material are notcontained, the environment can become contaminated and may be a source of infection forpersonnel who directly contact surfaces contaminated with aerosols , and airborne spread ofinfection may also be po ssible.
PREVENTION OF INFECTION
An effective, comprehensive program of controlling potential risks associated with suctioning procedures , both to patients and patientcare personnel, involves consistent and realistic use of aseptic technique throughout anysuction-related procedure .
Aspirated material sho uld never be allowedto come in contact with patient ca re workers ,either before it is suctioned (i .e., when the patient is disconnected from a respiratory support mechanism) , during suctioning, or whilebeing transported through patient care areas ."
Hands should always, be washed before andafter each patient contact and after handlingpotentially contaminated suctioned body fluidsand suction equipment.
Endotracheal suctioning should be performedaseptically ." Personnel should wear sterilegloves and use sterile catheters, and sterile saline so lu tion or water shou ld be used for flushing ca theters . A new, sterile ca theter should beused for each entry into the trachea." The samecatheter, however, can be reused to suction th eoropharynx after endotracheal suctioning iscompleted. When a new ca the ter cannot beused for each suctioning, catheters should bedisinfected between use as follows: soak thecatheter in 90% hydrogen peroxide and rinse itin a 70% solution of isopropy l or ethyl alcohol."Dry the catheter with a sterile cloth, and wrapit in a dry sterile towel. Before using the catheter again, rinse it in sterile water. If this les sthan-optimal procedure is employed, never
reuse catheters for mo re th an one 8-hour workshift.
Suction catheters and lin es used for endotracheal suct ioning sho uld be tran sp arent to allowpersonnel to observe resid ua l sec re tions .
If tenacious mucou s secretions a re a problem, suc tion ca the te rs ca n be flush ed withst erile solution before and during oropharyngeal suctioning . If mul tiple-use bottles of sterilesolution are used, they must remain cappedand be changed at least every 12 hours." A newsterile basin or container should be used tohold the sterile solution for each suctioningprocedure.
The collect ion vessel sho u ld re tain all materi al s suc tioned . Therefore the re shou ld be effecti ve anti-overflow devices incorporated inth e sys te m, i.e., sh uto ff va lves th at respond tolevel s of both foam and liquid ." Su ction co ntainers not having anti-overflow device s kn ownto be effective sho uld be changed before theyare three-fourths full , and in no event shouldth ey con tinue to be used whe n surg ing or fro thing wets the exhaus t port (or an exhaus t filter, ifpresent).
Reusable or disposable suc tion bottles andtubin g in use contain potentiall y hazardous secretions . To minimize th e associa ted risk, suction collection units and associa ted suctiontubing should be changed at least every 8 to 12hours, ideally between each hospital shift andin all circumstances between use on patients.When not in use, tubing should be suspended soas to prevent any environ me ntal contamination from the remaining fluid material.
All con taminated su ct ion supplies sh ould beplaced immediatel y in an impervious (plast ic)bag for transport from pat ient ca re areas .Reusable supplies shou ld be taken for rep rocessing to central se rv ice departments; di sp osa bles should be disca rded appropria tely .
After use , nondisp osable suction bottlesshould be handled away from patient ca reareas . (i .e., opened. emptied carefully to prevent conta mina tion on the outside of the bottleas well as the hands, and sealed in an imperv ious bag). Bottles should be thoroughly was hedand then either di sinfected or ster ilized beforebeing reused. High-temperature (180 0 C orhigher), high-pressure washers clean and disin-
74 Pugliese, Mackel, and Mallison
fect satisfactorily in the same process; or bottles can be steam sterilized after thoroughwashing. All personnel responsible for emptying, cleaning, and/or sterilizing suction equipment should be trained in proper methods ofhandling, including good personal hygiene.
If possible, disposable collection bottlesshould be used for patients with known infectious secretions, e.g., such as those associatedwith bacterial pneumonia. When disposablesuction bottles and tubing are used, handling inpatient care areas should be kept to a minimum; under no circumstances should theseunits be opened or emptied in patient careareas. Disposable collection pouches or vesselsshould not be reused.
Since there is a potential for aerosol production during suctioning, which contaminatestubing, vacuum fittings, regulators, and pumpsof portable suction machines, containment ofthese aerosols is essential. Therefore it is recommended that high-efficiency bacterial filtersbe used on suction collection systems to minimize the transmission of aerosolized microorganisms or particulate matter." Ideally, such afilter should be situated between the collectionbottle and vacuum source."
All personnel involved in suctioning procedures or handling contaminated equipmentshould be properly trained to minimize contamination of the environment and prevent infection risks not only to the patient undergoingsuction procedures and other patients, but tothemselves as well.
References
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