Contamination In Anesthesia Are you in Harm’s Way? · Breathing systems may become contaminated with microorganisms of patient origin (e.g. aerosols, sputum, blood or exhaled air).

Contamination In Anesthesia

Are you in Harm’s Way?

mc_Upper Airway 9/99

James M. Maguire, Ph.D., FCCP

Risks Increase with By-Pass


Of Upper Airway

Breathing System Can Become

Contaminated & Act as a Reservoir

for a Wide Variety of Micro-

Organisms


Organisms

Magath TB. Method for preventing cross-infection with gas machines. Anaesth and Analg 1938: 17;215-217.

Gross GL. Decontamination of anaesthetic apparatus. Anesthesiology 1955: 16;903-909.

Murphy PM, et al. Viability and distribution of bacteria after passage through a circle anaesthetic system. British Journal

of Anaesthesia 1991: 66;300-304.

Breathing systems may become contaminated with microorganisms of patient origin (e.g. aerosols, sputum, blood or exhaled air).


• “Hospital Acquired Pneumonia is currently the Most Common Fatal Nosocomial Infection in the U.S.”

• “The Most Important Factor Predisposing to


• “The Most Important Factor Predisposing to Nosocomial Pneumonia is Endotracheal Intubation” (17-20% Frequencies)

• “The Incidence of Nosocomial Pneumonia for Intubated Patients Appears to be 4 Times Higher Than That for Non-Intubated Patients”

(J.E. Pennington, 1987)

Nosocomial Infections

affects 1 in 20 patients and kills more people than car accidents and


people than car accidents and homicides combined. The CDC estimated in 1995, nosocomial infections cost $4.5 billion and contributed to more than 88,000 deaths - one death every 6 minutes.

Study Design• 20 sets of anesthesia machine cultures

obtained randomly

– 6 month, 750 tertiary care hospital

• Culture sites


• Culture sites

– Inspiratory valve

– Expiratory valve

– CO2 canister

– Bellows

ASA Abstracts, Anesth. MAC. CONT. JHJ Brooks MD et al,

Anesth. V75, NO3A Sep 91 (A874)

Study Results• 25% circle systems cultures --

positive

– Staphyloccus (coagulase neg)


– Staphyloccus (coagulase neg)

– Pseudomonas like organisms

• A culture site in circle system was positive in one or more machines.



44% Anesthesia Ventilators

Were Contaminated

• Organisms identified:

– Klebsiella pneumoniae


– Klebsiella pneumoniae

– Pseudomonas aeruginosa

– Xanthomonas maltophilia

– Comomonas acidovorans

– Aspergillus sp.



Machine ContaminationAcinetobacter baumannii outbreak ICU

Multiresistant strain, 29 patients


Multiresistant strain, 29 patients

Respiratory tract colonized first

Environmental cultures – negative

ICU closed and cleaned – no impact

Found A. baumanni in vents

Persistent A. baumannii? Look inside your medical equipment. Bernards et al. Infect Cont Hosp Epid. 2004;25:1002-04

A Comparative Study of Bacterial Contamination

of Reusable & Disposable Soda Lime Absorbers

Disposable Reusable

Number of 34 46


Number ofUnits

34 46

NumberContaminated

16 20

%Contaminated 47 43

Organisms Found: Staphylococcus aureus & Proteus mirabilis

After: Chrusciel et al. 1988.

Soda Lime and Contamination

• Gas flow is turbulent

• This serves to suspend micro-organisms, thus


• This serves to suspend micro-organisms, thus

• Absorbers could actually serve to concentrate the number and diversity of these organisms when used for patient after patient

Langevin et al. Chest Vol 115: 1107-14. Apr 99


• Number of organisms in inspiratory and expiratory tubing no different

• TB survived as long as 48 hours in


• TB survived as long as 48 hours in soda lime environment

• Soda Lime was not bactericidal for any of the organisms tested ( S. aureus, P. aeruginosa, TB)

Langevin et al. Chest Vo 115 p 1107-14. Apr 1999


This investigation, and others,


This investigation, and others, conclusively demonstrate organisms can be transmitted through currently designed anesthesia delivery systems

Langevin et al. Chest Vol 115: p 1107-14. Apr 99


Suggestions to Decrease Risk

• Use Competent HMEF at patient wye


• Use Competent HMEF at patient wye

• Place Competent Filter anywhere before the expiratory valve

• Disrupt gas flow for longer than 1 hour

Langevin et al. Chest Vol 115: p 1107-14. Apr 1999

AIDS Heightened Awareness

But


Patient may be a supermarket of organisms HIV, Hepatitis, Herpes, TB,

SARS etc.

You Just Don’t Know

• CDC


• CDC

• JCAHO

• OSHA

GrossBlood

OccultBlood Blood

Traumatic (n=32) 72% 28% 100%


Atraumatic

All

(n=58) 34% 45% 79%

Intubations (n=90) 48% 38% 86%

REF Anesthesiology Review Vol. XVII No. 5 Sept/Oct 1990

Incidence of Oral Bleeding After Oral Endotracheal Intubation

Kanefield et al

TB Outbreak

• Patient in 2 hospital for 3 weeks before diagnosed with TB

• HIV status masked TB


• HIV status masked TB

• 4 patients 1 employee secondary infection

• 1,045 contacts in hospital

• 56 staff tested positive, 39 patientsMMRI March 19, 2004/53(10); 214-216

XDR TB

• Isoniazid and Rifampin Resistant

• Second Line Antibiotics


• CDC-Widely distributed in USA

• 74 Known cases in USA

• Treatment? Surgery

• Good news, TB rate all time low in USA – 4.8 per 100,000

Breathing Circuit Barrier

must be EFFECTIVE


must be EFFECTIVE

Bacteria and Virus

Selective Filtration Devices:

Technological Developments• Absolute

Direct Interception Screen

• NominalDepth Filtration

• Advanced

+ / -

mc_Upper Airway 9/99Technological Expertise

Direct Interception

Inertial Impaction

Diffusional Interception+

Media Selection+

Surface Modification=

SELECTIVE FILTRATION DEVICE

HEPA


High Efficiency Particulate Arrestance

HEPA

• Defined as having a demonstrated and documented minimum removal


and documented minimum removal efficiency of 99.97% of particles 0.3 microns in size.

MMWR Vol. 43/No. RR-13

Research Interpretation

• Many manufacturers like to cite their removal claims using independent


removal claims using independent labs.

• It is imperative that these claims be viewed closely.

Research Interpretation• Claim 1

– Claim• 99% effective vs. 0.3 micron

– Test


– Test• MIL SPEC 39654C, 4.4.1.1.1 and 4.4.1.2

– Test Results• Particle size 3.0 micron

– Avg. efficiency of filter• 98.6%

MIDECO Inc. Research Report #48536 - Aug. 3, 1988

Research Interpretation

• Claim 2– Claim


– Claim• HEPA filtration – Bacteriophage .02

micron

– Test Results• Greater than 99.99% removal

3.1 Micron mean particle size

Nelson Laboratories, Inc. SOP/ARO/014 Lab #45781

Particle Inclusions, Drawn to Scale,

That May Be Found in a Carrier Gas

ThreeThree--micron micron


micron micron diameter diameter dropletdroplet

0.7-micron diameter bacterium(P.aeruginosa, Klebsiella, Proteus,

Acinetobacter, etc.)

One-micron diameter droplet

1.3-micron diameter ribavirin particle

0.9-micron diameter pentamidine droplet

Virus particle

0.3-micron Pseudomonas diminuta

0.3 -micronTubercle bacillus

Tested Against:

• Monodisperse Bacteria • Pseudomonas diminuta

• MS2

• 0.3 µm


• Virus

• For Comparison

• MS2 Bacteriophage

• HIV

• HCV

• 0.02 µm

• 0.1 µm

• 0.03 µm

Efficiency for Bacteria Greater than 99.999%Efficiency for Virus Greater than 99.9999%

Table 4. Filtration Efficiencies (%) with an Airborne

Bacterial Challenge (108 Mondispersed Ps. diminuta)

Experiment Edith PallBB50T

Hygrobac Filtatherm Filtaguard

1 6.8 99.9999 99.98 99.9999 99.9998


2 35 99.9996 99.95 99.9993 99.994

3 63 99.9999 99.987 99.9999 99.9997

4 6 99.9991 99.96 99.9997 99.9993

5 40 99.9995 99.98 99.98 99.9986

Hedley and Allt-Graham, A Comparison of the Filtration Properties of

Heat and Moisture Exchangers, Anesthesia 1992 Vol. 47. P414-420

It is prudent to use devices

which would provide a

minimal margin of error,

since each additional inhaled


since each additional inhaled

TB bacillus( or any pathogen)

may increase the risk of

disease.

Centers for Disease Control

There is no known safe

exposure level for TB, H1N1 and


exposure level for TB, H1N1 and

many other pathogens

Centers for Disease Control

Table 3. Filtration Efficiencies (%) with Liquid-Borne

Bacterial Challenge (108 Ps. diminuta, in 100 ml water)

Experiment Edith PallBB50T

Hygrobac Filtatherm Filtaguard

1 0 100* 59 54 0


2 2.1 100* 47 52 61

3 42 100* 53 75 65

4 65 100* 25 63 40

5 68 100* 21 66 0

Hedley and Allt-Graham, A Comparison of the Filtration Properties of Heat and Moisture Exchangers, Anesthesia 1992 Vol. 47. P414-420

* Liquid did not pass through the device.

1/1 passed4/4 failedM.luteus4

3/3 passed8/9 failedWater5

1/1 passed3/3 failedS.marcescens3

1/1 passed3/3 failedP.aeruginosa3

1/1 passed3/3 failedS.aureus3

1/11,2 passed4/41 and 5/52 failedB.diminuta1,2

HydrophobicFilter

Electrostatic Filter

Testmedium/ –microorganism


1. Hedley & Alt-Graham, 1992; Anaesthesia 47: 414-420

2. Lee et al., 1992; Brit J Anaesthesia 69: 522 - 525

3. Rosales & Dominguez, 1997; 2nd Int Conf on Prev Inf May

4. Miorini et al., 1991; Hyg. + Med. 16: 253 - 257

1/1 passed1/1 failedHIV8

1/1 passed-Prion-Protein9

1/1 passed1/1 failedHepatitis C Virus7



5. Frankenberger et al.,1995; Anaesthesist 44: 581 - 584

6. Wilkes, 2002; Anaesthesia 57: 33 - 39

7. Lloyd et al., 1997; Anaes Int Care 25: 235-238

8 .Lloyd et al.,1997; CAMR

9. Capewell, 2004; Pall Technischer Report

Slide byMP

Electrostatic vs Mechanical Filters

• ... some filters allowed over 40,000 times more particles to pass through than other filters........


• Pleated hydrophobic filters allowed significantly fewer particles to pass through than electrostatic filters.

Wilkes, et al. Anesthesia, 2002, 57, pages 162-168

Water in HMEF & Circuits

• Mimic condensation in circle system

• Tested 14 types-HMEF/HME/Filters


• RESULTS

• Hygroscopic devices – concealed water in devices – 10-45 ml

• Increased in resistance by 70-480%

Turnbull et al: Performance of breathing filters under wet conditions: a laboratory evaluation. Brit Journ of Anaesth (2005) 94 (5): 675-82

Water in HMEF and Circuits (cont)

• Ceramic hydrophobic pleated membrane filters did not absorb liquid ( concealment


filters did not absorb liquid ( concealment vol = 0 ml )

• Airflow resistance did not change in these devices.

• Turnbull et al: Performance of breathing filters under wet conditions: a laboratory evaluation. Brit Journ of Anaesth (2005) (5): 675-82

Water in HMEF & Circuits

Resistance

• Hydrophobic HMEF

• Hygroscopic

• Intersurgical = 9.5 cm


• Pall 25A = 3.8 cm

• Pall 100 = 2 cm

ISO Standard 8835 = 6 cm H20

• Intersurgical = 9.5 cm

• Vital Signs = 12.4 cm

• Draeger = 17 cm

• Gibeck = 7 cm

• Dar = 9 cm

• Datex = 11 cm

Review

• Hydrophobic

– Non wetting

– No significant

• Hygroscopic

– Absorbent when used with


– No significant resistance

– Impermeable to liquid

used with standard pressures

– Resistance increases when wet

– Porous to liquid

• The easiest way to Demonstrate the Ability of an HMEF to Prevent Breaching is to Create a Vertical Column of Water above the Medium and Determine at what Pressure


and Determine at what Pressure Breaching Occurs.

– DAR Hydrobac -- 13 cm H20

– Gibeck Humidivent -- 10 cm H20

– Intersurgical Filtertherm -- 14 cm H20

– Intertech HMEF -- 14 cm H20

– Pall BB-50T -- 104 cm H20Lee MG. et al. Bacterial Retention Properties of Heat and Moisture

Exchange Filters. Brit Jour Anesth 1992; 69:522-525

Electron Micrographs


Morgan Lloyd and Roe. Problems in Respiratory Care Vol. 4, No. 4 December 1991; 483.

An Alternative Strategy for Infection

Control of Anesthesia Breathing CircuitsChallenged with 108

Micrococcus luteus suspended in 5 ml salineaerosolized over 30 min pertrial x 10 trials totaling

Fresh Gas Inflow2 L /min

FGI

IV

1


Berry & Nolte; Anesth Analg 1991;72:651-5

trial x 10 trials totaling109 during 5 hours Hydrophobic

HME Filter

FGI

Ventilator

Culture Site

Test Lung

EV

CO2

Absorber

Culture Site

Trypticase soy

broth-moistened

swabs incubated

48 hrs

Tidal Volume = 600 ml8 cycles/min

Total flow = 6/8 L/min

1

2B

A

An Alternative Strategy for Infection

Control of Anesthesia Breathing

Circuits -- 100% Efficient!

Trial Site to

Aerosolize Bacteria

a

Hydrophobic HME Filter

Trial Duration

(h)b

Results


Bacteriaa Filter (h)

b

1 1 No 0.5 All Sites Were 2 2 No 0.5 Positive for M. luteus

3 1 Yes 5.0 All Cultures Were 4 2 Yes 5.0 Negative

Berry & Nolte; Anesth Analg 1991;72:651-5

a See Figure 1 and Text

b 108 Micrococcus luteus aerosolized every 0.5 h

Bacterial Contamination And

The Effect Of Filters In

Anesthetic Circuits In A

Simulated Patient Model


Simulated Patient Model

Authors -- D.T.M. Leijten, V.S. Rejger, R.P. MoutonJournal -- Journal of Hospital Infection,

(1992) 21, 51-60Affiliation -- University of Leiden, Rijnsburgerweg,

The Netherlands

I. This Study Addresses Two Major

Questions:

A. Can bacteria laden droplets, such as those expelled by patients receiving


those expelled by patients receiving anesthesia, contaminate the interior of anesthetic circuits?

B. What effect will filters have in ensuring optimal protection of circuit, equipment, patients and healthcare personnel?

Experiment 1

• Question– What is the extent of circuit contamination at a

flow of 1 l/m?


• Answer

– Entire circuit contaminated including the harmonica bellows and the 1.5 liter rubber reservoir bag inside the NS650.

Experiment 2

• Question

– What is the influence of higher gas flows on contamination? Gas flow 6 l/m.


• Answer

– Higher gas flows are associated with decreased levels of contamination.

– The authors surmise that this decrease is due to more of the bacteria being expelled through the gas evacuation tubing.

Experiment 5

• Question– What are the effects of using an HMEF

(Pall) on circuit contamination?


• Answer

– When the HMEF was used at the patient wye, there was no detectable contamination of the circuit, even when challenged by high concentrations of the organism (in the order of 100 million organisms).

Albrecht’s Study--

Five year experience with the development

of an individually clean anesthesia system.

• This study showed no decrease in post-


• This study showed no decrease in post-operative infections if the tubing is changed but not the soda lime.

• Infection rates decreased only when all components, including the soda lime absorber, were replaced clean for every patient.

Anesth Analg;53:24-28

IV.• “The fact that the anesthetic

apparatus may become contaminated should always be taken into account, since our


taken into account, since our investigations shows that

– without the use of a filter, the mere routine changing of tubing in the anesthetic circuit is unlikely to prove an optimal preventive measure.”

Circuit ReuseDevice N Patient

Side ofFilter

CircuitSide ofFilter

HMEF (PallBB25A)

59 17 0


BB25A)

0 2

Abstract presented at the AANA Annual Meeting, 1997

Determining the Effectiveness of the Pall BB25A HME Filter as a Bidirectional Barrier to the Transmission of

Bacteria During Inhalational Anesthesia.Tischler, et al. Henry Ford Hospital, Detroit, MI.

This study was supported by a grant from the AANA.

• “This field study supports the manufacturer’s claim that the Pall BB25A is a safe and effective bi-directional barrier to the transmission of bacteria between the anesthesia breathing circuit and the patient.”

Extended Use of An Anesthesia

Circuit

Circuits Used for 3 days.

66 Patients


21 Patient side contamination

7 Machine side contamination

No correlation between organism

Filter demonstrated bi-directional effectiveness

The Effectiveness of the Pall BB25A HME Filter During Extended Use of An Anesthesia Circuit. Hanover et al. AANA Journal, Oct 1999/vol 67, No.5, Pg 448

Circuit Reuse

“Among the three BFs tested ( Pall BB25A, DAR Barrierbac S, Baxter Airlife), only the Pall BB25A


Airlife), only the Pall BB25A completely prevented the passage of M.chelonae….”

An In Vivo Evaluation of the Mycobacterial Filtration Efficacy of 3 BF Used in Anesth. Anesth, V 101, No 1, July 2004. Pps 104-09

Circuit Use Between Patients• Others

• Show FDA cleared claim for circuit use for 24 hours. (not for multiple patients).

• Pall

• FDA cleared claim for circuit use between multiple


multiple patients).

• Show FDA cleared claim that the HMEF can be used for 24 hours.

• None of the above allows for circuit use between patients.

between multiple patients for 24 hours.

• Must use a Pall HMEF.

Circuit Reuse

It must be stated on the circuit insert


It must be stated on the circuit insert that the circuit can be used for

multiple patients. Nothing else is acceptable.

Blood Borne Pathogens

• Urban, university based surgical practice

• 709 consecutive operative cases (03-04)

• 53% were tested for HIV, Hep C & B


• 53% were tested for HIV, Hep C & B (based on history)

• 38% of all operations had a blood borne pathogen

• HIV=26% HCV=35% HBV=4% HIV/HCV =17%

• 48% of men tested positive

Prevalence of blood-borne pathogens in an urban, university-based general surgical practice. Weiss et al. An of Surg May 2005 241; (5): 803-807

Infection blamed Infection blamed

on gas tubeon gas tube

A DEADLY virus

THE DAILY TELEGRAPH MIRRORTHE DAILY TELEGRAPH MIRROR


THE DAILY TELEGRAPH MIRROR, Saturday, pg. 9, May 21, 1994

A DEADLY virus almost certainly

spread from patient to patient at a

Sydney private hospital through anesthetic tubes.

Transmission of Hepatitis C in a

Hospital Anesthesia Department

New South Wales Public Health Bulletin


New South Wales Public Health BulletinVolume 5, Number 5, May 1994 Tracheal

bleeding caused by intubation

–Case A coughed into tubing, introducing respiratory secretions into reusable part of circuitry

•Transmitted HCV to other patients via droplets

It was the coincidence of two clinically jaundiced patients which drew attention to the


clinically jaundiced patients which drew attention to the

incident.

Nosocomial Transmission HCV• Nurse/Patient Contracts HCV After

Surgery

• Prior Patient Known Carrier of HCV


• Prior Patient Known Carrier of HCV

• Testing Indicates Same Genotype

• Suggest Transmission Occurred from Respiratory Aerosols from Anesthesia Equipment

Heinson, et al. Journ Hosp Infec (2000)46:309-13

Litigation and Anesthesia Practice

Litigation against a hospital could not be discounted if filters were used with a known poor comparative performance.


known poor comparative performance.

“Merely using any filter during anesthesia may not be an adequate defense in court if cross-contamination did occur. The overall cost between filters is small compared to overall cost of the surgical procedure.”

Wilkes, et al.

Electrostatic vs Mechanical Filters

• ... some filters allowed over 40,000 times more particles to pass through than other filters........


• Pleated hydrophobic filters allowed significantly fewer particles to pass through than electrostatic filters.

Wilkes, et al. Anesthesia, 2002, 57, pages 162-168

Anaesthesia & Exposure-Prone

Procedures• Both anaesthetic and intensive therapy

ventilators have been shown to be the cause of cross-infection.


of cross-infection.

• Of the filters currently available, only those which use a pleated, hydrophobic membranereliably prevent contamination of the breathing system.

– Such filters also meet international standards for humidification and resistance to flow.

Association of British and Irish Anaesthesia

Institute of Medicine Report

“ The status quo is not acceptable and cannot be tolerated any longer”.


“Health Care is a decade or more behind other high-risk industries in its attention to ensuring basic safety”.

“Occupational hazards for

health care workers: diverse,

undefined, and not fully

appreciated”


appreciated”

R.M. Moore & C.A. Kaczmarek, (FDA)

Am.J. Infect. Control, 18, 316-327 (1991)

Chemicals in Surgical Smoke

• 45 Chemicals Identified in Smoke

AcroleinAcetonitrileAcrylonitrileBenzene

Hydrogen Cyanide

Polyaromatic-Hydrocarbons


BenzeneCarbon

MonoxideFormaldehyde

HydrocarbonsStyreneTolueneXylene

Hensman C, Baty D, Willis RG, Cuschieri A. Chemical composition of smoke produced by

high-frequency electrosurgery in a closed gaseous environment. An in vitro study. Surg

Endosc. 1998; 12(8):1017-9.

Sagar PM, Meagher A, Sobczak S, Wolff BG. Chemical composition and potential hazards of

electrocautery smoke. Br J Surg. 1996; 83(12): 1792.

Chemicals: Danger to O.R. Staff

• Cytotoxic

• Mutagenic

• Carcinogenic

• Teratogenic


Mutagenic Condensate

Laser: 1g tissue

Electrosurgery: 1g tissue

3 Cigarettes

6 Cigarettes

OSHA Preambles Air Contaminants (29 CFR 1910.1000) VI. Health Effects Discussion and

Determination of Final PEL.

Tomita Y, Mihashi S, Nagata K, Ueda S, Fujiki M, Hirano M, Hirohata T. Mutagenicity of

smoke condensation induced by CO2-laser irradiation and electrocauterization. Mutat Res.

1981; 89:145.

Chemicals: Danger to O.R. Staff

• Noxious Odor is Caused by Chemicals

• Headaches

• Irritants


• Irritants

– Eyes

– Nose

– Throat

• Regulated by OSHAOtt DE. Smoke production and smoke reduction in endoscopic surgery: preliminary report.

Endosc Surg Allied Tech. 1993; 1:230-3.

Moss CE, Bryant C, Stewart J, Wong WZ, Fleeger A, Gunter BJ. Health Hazard Evaluation

Report. National Institute for Occupational Health (NIOSH) No. 88-101-208.1990.

Hoglan M. Potential hazards from electrocautery plume. Canadian Operating Room Nurs J.

1995; 13(4):10-16.

SARS

"For example, in Hong Kong, 22% of


"For example, in Hong Kong, 22% of the deaths were among health care

workers, in Canada 50%, and in Taiwan, more than 90% of the

infections occurred in hospitals.

SARS

50% of Known Cases – HCWs

Ontario Ministry of Health Recommendations:


Recommendations:

“….A hydrophobic submicron filtermust be placed between the endotracheal tube and the ventilator circuit tubing”

Influenza-Associated Deaths Are

Similar to Other Important Causes

of Death in Adults

VPD's Adults

Colorectal CA

Breast CA

Prostate CA

Influenza


0 10,000 20,000 30,000 40,000 50,000 60,000 70,000

Prostate CA

Suicide

Parkinson's

HIV

VPD's Kids

Range of

VPD

deaths in

adults

VPD, vaccine-preventable disease

Adapted from: CDC, NCHS (online data for 2000); CDC Summary of Notifiable Diseases, US 2003; MMWR 52(54):1-85; CDC National Vital Statistics System, Deaths: Final Data for 2000; 2002; 50 (15). Thompson WW, et al. JAMA. 2003;289-179-186.

j1

Slide 71

j1 Please add before the footnote

VPD, vaccine-preventable diseasejjablonski, 7/25/2007

The Pall BB25 shows no detection* of prion proteins following liquid challenge with 1% hamster brain homogenate as the challenge solution.

BB25 prion validation


the challenge solution.

* As assayed using Western Blot analysis with a detection limit of

approx. 10 µg protein

Advantages of Using a Bacterial/

Viral HMEF

• Easy to use

• Mimics the nasopharynx

• Needs no power source


• Needs no power source

• Isolates patient from the circuit, equipment, and from HCW

• May change circuits less frequently – FDA Cleared

• Eliminates need for other filters on the circuit

• Decrease hazardous waste

• Cost effective

THE HOSPITAL MUST TAKE INTO CONSIDERATION THE SAFETY OF ITS PATIENTS


INTO CONSIDERATION THE SAFETY OF ITS PATIENTS

AND WORKERS.

Pall Multiple Patient Anesthesia Circuits:

Features & Benefits

Benefits:

• Increased patient/clinician protection

Features:• Pall Ultipor®25 filter

• Circuit can be used on


• Faster operating room turnover time

• Less waste generated

• Less storage space needed

• Circuit can be used on multiple patients within a 24-hour period*

• Environmentally friendly

*FDA 510(k) clearance for reuse of the circuit on multiple patients

within a 24-hour period (when used with the Pall Ultipor® 25 filter).

In Harms Way

Protect Staff


Protect Patients

Thank You

Contamination In Anesthesia Are you in Harm’s Way? · Breathing systems may become contaminated with microorganisms of patient origin (e.g. aerosols, sputum, blood or exhaled air).

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