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Dears, I was wondering if you could advise me or direct me to some guidance about the reuse of oxygen tubing in resource poor setting, I know it shouldn't happen but it does so i am trying to make the practice safer if possible. This may not be exactly the correct forum but it is relevant enough and you may have some experience with this. In my current work place there is a practice of reuse of 02 tubing- is there anyway to improve the safety of this practice eg. autoclaving of tubing? I am sure the tubing is a source of Klebsiella infection.

 
S. Mehtar
Replied at 6:45 AM, 29 Apr 2013

Dear Unarose
At our hospital we had a Serratia marcesens outbreak in the NNU affecting 12 babies and killing4. We had Klebs outbreaks in several ICUs. The cost of treating each infection was between R250,000 and R350,000. This information was presented to the powers that be and we have now moved to disposable single patient use respirator tubing. What is wonderfully interesting is that the minute they reuse a tube, either a Serratia or a Klebsiella emerges and we know!! As for TB, we advocate single patient use obviously but we have expiratory filters and ventilation tubing filters as well to protect the machines. We advocate close suction obviously for TB cases but what is interesting is that staff have stopped using respiratory PPE when suctioning! Patients in ICUs with closed suctioning still cough!
I would not advocate sterilization but what you can do if you have the right washer disinfector with a respiratory tubing mount is to load up the machine which will wash and disinfect at over 85 degrees for 3 minutes and that is all you need actually. The tubing MUST come out dry- to prevent the GNB from emerging.
I hope this helps
S

Prof Shaheen Mehtar

Buitengewoon Professor (Waarnemende Hoof: UIPC) / Extraordinary Professor (Acting Head: UIPC)

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Eenheid vir Infeksievoorkoming en Beheer / Unit for Infection Prevention and Control
Fakulteit Geneeskunde en Gesondheidswetenskappe /
Faculty of Medicine and Health Sciences
Universiteit Stellenbosch University
Posbus / PO Box 19063; Francie van Zijl Rylaan / Drive
TYGERBERG 7505
Suid-Afrika / South Africa
Tel: +27 21 938-5054; Faks / fax: +27 21 931-5065
e-pos / e-mail: <mailto:>
Visit our website at www.sun.ac.za/uipc<http://www.sun.ac.za/uipc>
5th ICAN/ IPNET-K conference, 6-8th Nov, 2013, Mombasa, Kenya. www.ICNetwork.co.za

Edward Nardell, MD
Replied at 1:07 PM, 29 Apr 2013

Shaheen,

Can an intubated patient get aerosol into the room with a closed system
even if they cough? The balloon should prevent anything from exiting at
the mouth (of course no seal is 100%) and the sleeve keeps anything exiting
at the port. What am I missing?

S. Mehtar
Replied at 2:04 PM, 29 Apr 2013

I thought it would get someone's attention. Yes, there is leakage around the balloon especially when the patient coughs during suction. We have certainly seen it sometimes- just a clinical concern for me but I think we should still recommend wearing PPE when suctioning patients even with closed suction.
I hope this helps

Shaheen



Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Eng)
Chair Infection Control Africa Network (ICAN)

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