Care Cleaning Disinfection and Sterilization

Care, cleaning, disinfection and sterilization
of respiratory devices

CHECKLIST 1 Bedside oxygen concentrators
CHECKLIST 2 High flow nasal cannula
CHECKLIST 3 BiPAP/CPAP
CHECKLIST 4 Pulse oximeters and vital sign monitors
CHECKLIST 5 Invasive mechanical ventilators
CHECKLIST 6 Sterile services department
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Care, cleaning and disinfection of
definitions
Cleaning, disinfection and sterilization are the backbone
of infection prevention and control in hospitals and
or other health care facilities. The type and level of
decontamination depends on the nature of the device and
the use to be given to it. All persons who are responsible for
handling and reprocessing contaminated elements must:
• Receive adequate training and periodic retraining.
• Use appropriate personal protective equipment.
Cleaning is an activity that removes organic and inorganic materials or dirt that is
on the device surfaces with the main purpose of removing conditions that would enable
the growth of microorganisms. Cleaning also allow the disinfectant to come into contact
with items to kill microorganisms.
This is a mechanical activity mainly done with soaps or detergents with different pH
levels that help to remove the dirt material. After washing, objects should be carefully
rinsed in order to eliminate any residual chemicals and then dried.
Disinfection is an activity that consists of eliminating many of the pathogenic

microorganisms that live on the device’s surfaces. It should be performed just after a
cleaning activity to guarantee that all other organic material has been removed.
This can be done with chemical and/or heating activities depending on the nature
of the type of equipment, disinfectant used and processes selected. The disinfection
approach should be selected based on its documented effectiveness with different
microorganisms, including viruses, bacteria and fungi that might be contaminating
the device. Chemicals used should have a sanitary registration for use in medical
environments and must be recommended by the manufacturer.
Sterilization is the process that eliminates all living microorganisms including

spores from surfaces. It should be performed just after cleaning and disinfection
activities to guarantee that organic material and most pathogenic microorganism have
been removed.
This can done with mechanical, e.g. steam sterilization, or chemical activity,
e.g. ethylene oxide.
CHECKLIST 1
Care, cleaning and disinfection
of oxygen concentrators
Between patients
Always read and follow the instructions and recommendations
of the manufacturer’s manual
Consumables associated with oxygen delivery are generally intended
as single use devices. They should be treated as infectious1 material
and disposed of accordingly. Disposal of patient interface, tubing,
water bag and water chamber, for example, should be done as per
facility standard operating procedures for infectious/biohazardous waste
management.
DURING OXYGEN THERAPY (same patient)

Before starting any hygiene tasks, please take preventative measures to ensure that:
All electrical medical equipment are disconnected from power supply while tasks are being done; and,
activities are performed away from the medical wards, preferably in biomedical workshops.
Task Description
Humidifier must be washed, Oxygen bubble humidifier (non-heated bottle) must be washed, rinsed, and
1. disinfected daily when used for the same patient and disposed after use.
rinsed, and disinfected daily2
1. Empty the water from the humidifier.
2. Rinse the humidifier flask under running water.
3. Fill in with proper distilled water or cold boiled water within the scale
between the top scale line and the lowest one.
4. Do not use tap water, even if it is safe drinkable water.
5. Do not use bottled water, even distilled, which has been stored in
warm conditions. (These conditions allow bacterial growth in the water
and increase the risk of patient infection).
Inspect and clean air intake filter 1. Pull the filter gently out and replace with spare one.
2.
(1-2 times per week) 2. Put the filter in cool, soapy water and swirl gently to remove debris.
3. Remove from soapy water and place it in shady area until completely dry.
4. Store the spare filter until next cleaning is needed.
Inspect the bacterial filter weekly Do not wash the bacterial filter in water. This filter should be cleaned or
3. changed by the maintenance department as per manufacturer’s instructions.
BETWEEN PATIENTS
After each patient use, the concentrator must be disconnected, cleaned, disinfected,
and stored appropriately in a clean environment before use on another patient
Task Description
1. Perform risk assessment prior Consider the patient care tasks that will need to be performed or additional
to entry of room risks that may be encountered during disconnection of the device.
2. Perform hand hygiene
3. Don appropriate personal PPE worn during disinfectant preparation should include surgical mask/
protective equipment (PPE) respirator, goggles or face shield, long-sleeved fluid resistant gown or
gown + apron, rubber gloves, and boots or closed work shoes.
4. Disconnect the device Turn off the device and disconnect from the patient and the power.
Task Description
5. Dispose of single use patient Ideally, dispose of single use patient interface, nasal cannula tubing in
interface (e.g. nasal cannula, designated infectious material/biohazardous waste container.
masks) tubing
6. Move the oxygen concentrator Move the oxygen concentrator away from patients and other equipment to
to a well-ventilated area a designated well-ventilated space where cleaning and disinfection of the
for cleaning device can be performed.
7. Change gloves Discard gloves in appropriate waste container, perform hand hygiene, and
don new gloves.
8. Wash humidifier Wash the humidifier in warm water using a mild detergent. Rinse the
humidifier and allow to air dry completely.
9. Wipe the external device Wipe the external device surfaces (all parts including flowmeter, controls
surfaces from top-to-bottom and LEDs, from top-to-bottom including controls) with a damp cloth or
with detergent (Cleaning) disposable wipe soaked in detergent and clean water and then wipe off
any remaining detergent residue with a dry lint-free cloth.
To avoid permanent damage, do not use excessive amounts of liquids to
clean the device.
Use mechanical action (scrubbing) and brushing, if necessary, along the
edges and joints to remove visible dirt deposits and calcifications.
10. Prepare disinfectant solutions Should always be performed before use, in well-ventilated areas away
from patients.
11. Wipe with disinfectant Prepare a fresh cloth or disposable wipe soaked in a compatible
disinfectant. Wipe the device from top to bottom, ensuring surfaces
of sensors/cables are wiped while avoiding contact with electrical
connectors.
0.1% sodium hypochlorite (1000 ppm) should only be used according
to the manufacturer’s instructions if device is known to withstand use of
chlorine-based agents and no ammonia-based cleaning agents or acidic
body fluids (e.g. urine) are present on the device.
Do not use different disinfectant formulations during the same disinfection
step, this may produce toxic fumes.
12. Remove PPE- wash hands Doff, discard PPE and perform hand hygiene.
13. Store cleaned oxygen Ensure cleaned oxygen concentrator is stored in an area where there is low
concentrator and disinfect risk of contamination between uses, and that at least 1 minute of contact
before new use time has elapsed after the application of the disinfectant before it is used
on next patient.
14. Stored devices should be If device is not in use, it should be cleaned as above twice per month.
cleaned twice a month
1 https://www.who.int/news-room/fact-sheets/detail/health-care-waste
2 https://www.primedeq.com/blog/cleaning-disinfection-and-proper-maintenance-of-oxygen-concentrators/
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CHECKLIST 1
CHECKLIST 2
high flow nasal cannula
During non-invasive ventilation and
between patients
of the manufacturer`s manual
as single use devices, should be treated as infectious material and
disposed of accordingly. Dispose of patient interface, tubing, water
bag and water chamber, for example, as per facility standard operating
procedures for infectious/biohazardous waste management.
DURING NON-INVASIVE VENTILATION (SAME PATIENT)

Task Description
1 Humidifier (water chamber) Oxygen bubble humidifier (non-heated bottle) must be washed, rinsed,
must be washed, rinsed, and disinfected regularly when used for the same patient and disposed
and disinfected daily after use between patients (if possible).
1. Empty the water from the humidifier.
2. Rinse the humidifier flask under running water.
3. Fill in with proper distilled water or cold boiled water within the scale
between the top scale line and the lowest one.
4. Do not use tap water (not-boiled), even if it is safe drinkable water.
Do not use bottled water, even distilled, which has been stored in warm
conditions. (These conditions allow bacterial growth in the water and
increase the risk of patient infection).
2 Check and change air and dust The filter can be weekly rinse under running water only if the procedure is
filters every 3 months and clean established in the manufacturer’s manual.
regularly as recommended
BETWEEN PATIENTS
After each patient use, the equipment must be must be cleaned, disinfected, and stored
appropriately in a clean environment before use on another patient
Task Description
1. Perform risk assessment prior to Consider the patient care tasks that will need to be performed or additional
entering the room risks that may be encountered during disconnection of the device.
4. Disconnect the device Turn off the device and disconnect from the patient, oxygen source and
the power.
Task Description
5. Properly dispose of single use Ideally, dispose of single use patient interface, nasal cannula tubing, water
patient interface, nasal cannula bag, and water chamber (after draining) in designated infectious material/
tubing, water bag, and water biohazardous waste container.
chamber (after draining)
6. Move the device to a well- Move the high flow nasal cannula device away from patients and other
ventilated area for cleaning equipment to a designated well-ventilated space where cleaning and
disinfection of the device can be performed.
7. Change gloves Discard gloves in appropriate waste container, perform hand hygiene, and
don new gloves.
8. Wipe exterior surfaces with • Wipe the external device surfaces (all parts, from top-to-bottom
detergent (Cleaning) including controls) with a damp cloth or disposable wipe soaked in
detergent and clean water and then wipe off any remaining detergent
residue with a dry lint-free cloth, to avoid permanent damage, do not
use excessive amounts of liquid to clean the device.
• Use mechanical action (scrubbing) and brushing, if necessary, along
the edges and joints to remove visible dirt deposits and calcifications.
from patients.
disinfectant, such as hydrogen peroxide >0.5% OR ethanol 70-90%; OR
as specified by the device manufacturer, and wipe the device from top to
bottom, avoiding contact with electrical connectors.
Different disinfectant formulations should never be used on the
same device during the same disinfection step, as this may produce
toxic fumes.
11. Use high level disinfection Some devices require high level disinfection, see instructions on the
when indicated manufacturer’s manual. Ensure the cycle of disinfection is complete before
drying and storing the device.
13. Store clean ventilator and Ensure cleaned high flow nasal cannula device is stored in an area
disinfect before use where there is low risk of contamination between uses, and that at least
1 minute of contact time haselapsed after the application of the
disinfectant before it is used on next patient.
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BiPAP/CPAP devices
Bilevel or two-level Positive Airway Pressure (BiPAP).
Continuous Positive Airway Pressure (CPAP)
During non-invasive ventilation and

between patients
of the manufacturer`s manual
as single use devices, should be treated as infectious material and
disposed of accordingly. Dispose of patient interface and filters, for exam-
ple, as per facility standard operating procedures for infectious/biohazardous
waste management.
DURING NON-INVASIVE VENTILATION (SAME PATIENT)

Task Description
1. Humidifier must be washed, Oxygen bubble humidifier (non-heated bottle) must be washed, rinsed,
rinsed, and disinfected daily and disinfected regularly when used for the same patient and after use
between patients.
Empty the water from the humidifier.
Rinse the humidifier flask under running water.
Fill in proper distilled water or cold boiled water within the scale between
the top scale line and the lowest one.
Do not use tap water (not-boiled), even if it is safe drinkable water.
Do not use bottled water, even distilled, which has been stored in warm
conditions. (These conditions allow bacterial growth in the water and
increase the risk of patient infection).
2. Check the air filter weekly and Replace more often if there are any holes or blockages by dirt, dust,
replace every 4 weeks or other organic matter.
BETWEEN PATIENTS
After each patient use, the BiPAP/CPAP must be cleaned, disinfected, and stored appropriately in a
clean environment before use on another patient
Task Description
1. Perform risk assessment prior Consider the patient care tasks that will need to be performed or
to entering the room additional risks during disconnection of the device.
4. Disconnect the device. Turn off the device and disconnect from the patient, oxygen source and
the power.
Task Description
5. Dispose of single use tubing, If patient is being permanently disconnected from BiPAP/CPAP device,
interface and filters in dispose of single use tubing, interface, and exhalation valve filters in
designated waste containers designated infectious material/biohazardous waste container.
6. Move the device to a well- Move the BiPAP/CPAP device away from patients and other equipment to
ventilated area for cleaning a designated well-ventilated space where cleaning and disinfection of the
device can be performed.
7. Change gloves Discard gloves in appropriate waste container, perform hand hygiene,
and don new gloves.
8. Wash humidifier Wash the humidifier in warm water using a mild detergent. Rinse the
humidifier thoroughly and allow to air dry completely.
9. Wipe with detergent and Wipe the exterior of the device from top to bottom weekly and between
clean water from top-to-bottom patients with a damp cloth or disposable wipe soaked in detergent and
(Cleaning) clean water and then wipe off any remaining detergent residue with a dry
lint-free cloth.
from patients.
connectors.
12. Remove PPE- wash hands Doff and discard PPE and perform hand hygiene.
13. Store clean BiPAP /CPAP and Ensure cleaned BiPAP/CPAP device is stored in an area where there is
disinfect before new use low risk of contamination between uses, and that at least 1 minute of
contact time has elapsed after the application of the chosen disinfectant
(or as specified by the manufacturer) before ventilator device is used
on a patient.
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pulse oximeters and patient
monitors devices
During monitoring and
between patients
Always read and follow the instructions and recommendations of
the manufacturer`s manual
The device must be cleaned and disinfected after each individual use
and, at minimum weekly, prior to use on another patient.
Task Description
to entry of room risks that may be encountered during disconnection of the device.
4. Turn-off and disconnect the Turn off the device and disconnect from the patient and the power and/
device from the patient and power or make sure the batteries are taken out and all patient connections are
removed when clinically safe to do so before cleaning.
5. Move device to a well-ventilated If monitoring device is not fixed to patient room/environment, move device
area for cleaning away from patients and other equipment to a designated well-ventilated
space where cleaning and disinfection of the device can be performed.
6. Wipe and clean with detergent Wipe the outer surfaces, sensors, and cables of the device from top to
(Cleaning) bottom with cloth or disposable wipe soaked in detergent and clean water
and then wipe off any remaining detergent residue with a dry lint-free cloth.
To avoid permanent damage, do not use excessive amounts of liquids to
clean the device.
from patients.
disinfectant, (e.g. hydrogen peroxide >0.5%, OR ethanol 70-90%; or
as specified by the monitor manufacturer). Wipe the device from top to
bottom, ensuring surfaces of sensors/cables are wiped while avoiding
contact with electrical connectors.
9. Remove PPE - wash hands Doff, discard PPE and perform hand hygiene.
Task Description
10. Store clean device and disinfect If device is not fixed to patient room/environment, ensure it is stored in
before new use an area where there is low risk of contamination between uses, and that
at least 1 minute of contact time has elapsed after the application of the
chosen disinfectant (or as specified by the manufacturer) before it is used
on a new patient.
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CHECKLIST 5
invasive mechanical ventilators
During ventilation and between patients
Always read and follow the instructions and
recommendations of the manufacturer`s manual
as single use devices, and should be treated as infectious material
and disposed of accordingly. Dispose of patient interface and filters,
for example, as per facility standard operating procedures for infectious/
biohazardous waste management.
During ventilation (same patient)

Task Description
1. Single-use breathing circuits are Changing circuits leads to the dispersion of contaminated droplets and
recommended and should not aerosols as well as increased use of medical resources.
be routinely changed for the
same patient
2. Place filter in both inspiratory and When using a disposable filter, the exhalation filter is required to be
expiratory end of the ventilator replaced when the resistance is increased.
The disposable filters can be used up to 48 hours before being
exchanged.
Replace the filter if the expiratory resistance increases or according to the
instructions for the filter, whichever comes first.
3. Drain water in lines daily On a daily basis, drain water in gas supply inlet filter, and check the
amount of liquid in the expiratory module water trap (the liquid volume
cannot be more than half of the bottle).
BETWEEN PATIENTS
After each patient use, the ventilator must be cleaned, disinfected, and stored appropriately in a
clean environment before use on another patient
Task Description
to entering the room risks that may be encountered during disconnection of the device.
4. Disconnect the device Turn off the device and disconnect from the patient, the oxygen source
and the power.
5. Properly dispose of single Dispose of single use breathing circuit and exhalation valve filters in
use breathing circuit and designated infectious material/biohazardous waste container.
exhalation valve filters
Task Description
6. Prepare closed container Place any components that will be sent for high-level disinfection
with components requiring (respiratory valve, active humidifier, flow sensor and expiratory tubing if
high-level disinfection used/indicated, and other connectors/components) in a designated closed
container for transport to sterile services department.
If it is indicated in the manufacturer’s manual, follow the instructions for
autoclaving parts of the ventilator that are specified for this process.
7. Move the mechanical ventilator Move the ventilator away from patient area and other equipment to a
to a well-ventilated area for designated well-ventilated space where cleaning and disinfection of the
cleaning device can be performed.
8. Change gloves Discard gloves in appropriate waste container, perform hand hygiene,
and don new gloves.
9. Wipe the external device Wipe the external ventilator surface (including controls, housing, trolley
surface from top-to-bottom and support arm, touch screen, power cord and gas supply hose) with a
with detergent (Cleaning) damp cloth or disposable wipe soaked in detergent and clean water and
then wipe off any remaining detergent residue with a dry lint-free cloth.
It is not necessary to routinely clean pressure lines within a ventilator
between patients (these lines are not exposed to the patient or the
patient’s respiratory secretions).
from patients.
connectors.
13. Store clean ventilator and Ensure cleaned ventilator is stored in an area where there is low risk of
disinfect before new use contamination between uses, and that at least 1 minute of contact time
has elapsed after the application of the disinfectant before it is used on
next patient.
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CHECKLIST 6
Care, cleaning and disinfection
of respiratory equipment in
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Equipment used for respiratory therapy (e.g. items that come into
contact with mucous membranes of the patient) is considered semi
a)
critical; such items should be cleaned and then receive high-level
b)
disinfection between patients.2
a)
b)
High-level disinfection of respiratory equipment takes place after
cleaning and is typically accomplished by physical methods or
chemical germicides.
Task Description
2. Don appropriate personal Don appropriate personal protective equipment as per facility protocol:
protective equipment PPE worn during disinfectant preparation should include surgical mask/
respirator, goggles or face shield, long-sleeved fluid resistant gown or
3. Wash with detergent and Wipe the external device surface with a damp cloth or disposable wipe
Rinse clean water (Cleaning) soaked in detergent and clean water and then wipe off any remaining
detergent residue with a dry lint-free cloth.
· Use mechanical action (scrubbing) and brushing, if necessary, along
the edges and joints to remove visible dirt deposits and calcifications.
4a. Disinfect Physical -Heat for Physical methods for high-level disinfection include steam (e.g.
heat resistant equipment; autoclaving at lower temperature) or hot-water disinfection at least 121°C
e.g., steam3, hot-water (pasteurization). Steam sterilization is an inexpensive and effective method
for sterilization or high-level disinfection.4
4b. Disinfect-chemicals for plastic If disinfectant solutions require preparation before use, this should
and other parts that can always be performed in well-ventilated areas away from patients.
be damaged by heat Prepare a fresh cloth or disposable wipe soaked in a compatible
disinfectant, such as hydrogen peroxide >0.5% OR ethanol 70-90%;
OR as specified by the device manufacturer, and wipe the device from top
to bottom, avoiding contact with electrical connectors.
· 0.1% sodium hypochlorite (1000 ppm) should only be used according
to the manufacturer’s instructions if device is known to withstand use
of chlorine-based agents and no ammonia-based cleaning agents or
acidic body fluids (e.g. urine) are present on the device (important to
remember to rinse well the rests of chlorine).
· Different disinfectant formulations should never be used on the
same device during the same disinfection step, as this may
produce toxic fumes.
Task Description
5a. Dry Dry equipment.
· Physical equipment (e.g. a washer, pasteurizer or autoclave) often has
a drying feature within the machine.
· After pasteurization, wet equipment is typically dried in a hot-air
drying cabinet ,or air drying, before storage. The equipment must be
inspected carefully to ensure there is no water left in the equipment.
· If using chemical disinfection, rinse with sterile or clean water (i.e.

5b. Chemical Methods water boiled for 5 minutes and cooled). Sterile water is preferred for
rinsing off residual liquid chemical disinfectant from a respiratory device
that has been chemically disinfected for reuse, because tap or distil-
led water may harbour microorganisms that can cause pneumonia.
However, when rinsing with sterile water is not feasible, instead, rinse
with tap water or filtered water (i.e. water passed through a 0.2 μ filter),
followed by an alcohol rinse and forced-air drying.
6. Store equipment dry in closed Store equipment dry in closed packages.

packages
1 N.B. It is recommended for all involved in sterile services to review OpenWHO course on Decontamination and sterilization of
medical devices: https://openwho.org/courses/IPC-DECON-EN As well as refer to WHO’s Decontamination and reprocessing of
medical devices for health-care facilities: https://apps.who.int/iris/handle/10665/250232)
2 Reference: https://www.who.int/publications/i/item/infection-prevention-and-control-of-epidemic-and-pandemic-prone-acute-
respiratory-infections-in-health-care
3 However, steam sterilization is unsuitable for processing plastics with low melting points, powders or anhydrous oils.
4 Pasteurization is a non-toxic, cost-effective alternative to high-level disinfection with chemical germicides.
Equipment should be submerged for at least 30 minutes in water at a temperature of about 70 °C (less than the temperature that
typically damages plastic).
Pasteurization can be accomplished using a commercial washer or pasteurizer.
Heat for heat-resistant equipment that can withstand high temperature (e.g. 80 °C); such equipment can be disinfected using a washer–
disinfector; if a washer or pasteurizer is not available, use a high-end or commercial dishwasher with a “sanitize” feature that can reach
70 °C.
Please refer to quality assurance and monitoring sections in WHO Guideline for Decontamination and reprocessing of medical devices
for health-care facilities: https://apps.who.int/iris/handle/10665/250232
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Care, cleaning, disinfection and sterilization

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Disinfection is an activity that consists of eliminating many of the pathogenic

Sterilization is the process that eliminates all living microorganisms including

DURING OXYGEN THERAPY (same patient)

2. Perform hand hygiene

DURING NON-INVASIVE VENTILATION (SAME PATIENT)

2. Perform hand hygiene

During non-invasive ventilation and

DURING NON-INVASIVE VENTILATION (SAME PATIENT)

2. Perform hand hygiene

2. Perform hand hygiene

During ventilation (same patient)

2. Perform hand hygiene

sterile services department1

· If using chemical disinfection, rinse with sterile or clean water (i.e.

6. Store equipment dry in closed Store equipment dry in closed packages.

All rights reserved.

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