5. PROCEDURES

5.1 J1 — Cleaning/Disinfection of the Anesthesia Work Area Between Cases

5.1.1 Principles

• A. Perform hand hygiene before and after cleaning tasks, and after glove removal.
• B. Use hospital-approved disinfectant wipes/solutions appropriate for the surface/device; follow required wet contact time.
• C. “Clean then disinfect”: if visible soil/blood/body fluid is present, remove gross contamination first, then disinfect.
• D. Prioritize high-touch surfaces within the anesthesia zone (see 5.1.3).
• E. Avoid cross-contamination: do not place clean supplies on contaminated surfaces; minimize storage of supplies on the cart top and remove items to allow cleaning. (Cambridge University Press & Assessment)

5.1.2 Required Frequency

• A. Between cases: high-touch anesthesia zone surfaces and any contaminated areas.
• B. Immediately after any spill/contamination with blood or body fluids: clean and disinfect affected surfaces and replace contaminated disposables.
• C. End of day: expanded wipe-down of anesthesia machine surfaces, cart exterior, monitors, and frequently touched equipment (coordinated with J2).

5.1.3 Minimum Between-Case Cleaning Checklist (Anesthesia Zone)

Clean/disinfect (at minimum):

• Anesthesia machine: APL valve, flow knobs, ventilator controls, screen/touchpoints, vaporizer controls/external surfaces, drawer handles, machine handles.
• Patient monitors: control knobs, alarm silence buttons, touchscreen, cables where handled.
• Anesthesia cart: top surface, handles, drawer fronts/pulls, keyboard/mouse/touchscreen (if present).
• Infusion pumps/syringe pumps: buttons, knobs, touchpoints; IV pole high-touch areas.
• Suction equipment: suction handle/external surfaces; replace single-use suction catheters as per practice.
• Work surfaces: medication preparation surface, charting area.
• Reusable items handled during airway management: external surfaces of reusable items per IFU; remove for reprocessing when required.

5.1.4 Injection Port / Needleless Connector Disinfection

• A. Disinfect injection ports/needleless connectors before access using 70% isopropyl alcohol (or facility-approved method) with friction and adequate contact time; allow to dry before access. (Anesthesia Patient Safety Foundation)
• B. Consider passive disinfection caps where adopted by facility policy, following manufacturer instructions. (Anesthesia Patient Safety Foundation)

5.1.5 Barriers and Single-Use Strategies

• A. Use barrier covers for selected high-touch surfaces (e.g., keyboard/touchscreen) when compatible with device IFU and local policy; remove and replace between cases if contaminated or as scheduled.
• B. Prefer single-use patient-contact items when appropriate (e.g., certain airway adjuncts), consistent with infection prevention guidance for anesthesia work areas. (shea-online.org)

5.1.6 Documentation

• A. Between-case cleaning shall be documented per unit workflow (turnover checklist, anesthesia tech log, or room turnover sheet).
• B. Any contamination events and corrective actions shall be recorded (spill log/incident report as applicable).

5.2 J2 — Anesthesia Machine Cleaning Policy (Per IFU + Local IPC)

5.2.1 General Requirements

• A. Clean/disinfect anesthesia machines after each case with focus on high-touch external surfaces, consistent with perioperative safety expectations and local IPC procedures. (istitlaa.ncc.gov.sa)
• B. Follow manufacturer IFU for all cleaning agents, methods, and prohibited substances to avoid device damage and ensure validated disinfection. (cdc.gov)

5.2.2 Between-Case (Turnover) Anesthesia Machine Cleaning

At minimum:

• Wipe high-touch external surfaces (controls, knobs, handles, screens/touchpoints).
• Replace/remove disposable breathing circuit components per facility practice and IFU.
• Replace/change any visibly contaminated components immediately.
• Confirm suction availability and replace suction consumables as required.

5.2.3 End-of-Day / Terminal Cleaning for Machine Surfaces

• A. Perform broader wipe-down of external surfaces and accessories, including monitor mounts, shelves, drawers, and storage bins as applicable.
• B. Coordinate with environmental services for room-level terminal cleaning while ensuring anesthesia-specific surfaces are included.

5.2.4 Breathing System / Accessories Handling (IFU-Driven)

• A. Breathing circuits and reusable components shall be managed per validated IFU and facility reprocessing decisions (single-use vs reusable).
• B. Any component designated reusable must follow CSSD/HLD/sterilization pathway appropriate to its classification and IFU. (cdc.gov)

5.2.5 Enhanced Measures for Pulmonary Infection / Heavy Contamination

• A. If the patient has suspected/confirmed pulmonary infection, heavy airway contamination, or gross contamination of the breathing system, follow enhanced cleaning/disinfection steps per IFU and local IPC escalation. (aana.com)

5.2.6 Documentation

• A. Document machine cleaning per local workflow (daily checklist and turnover log).
• B. Report device damage or cleaning-related malfunctions to biomedical engineering.

5.3 J3 — Reprocessing Pathway (Airway Devices, Ultrasound Probes, and Related Equipment)

5.3.1 Core Reprocessing Rules

• A. Reprocessing is determined by Spaulding classification and manufacturer IFU; if IFU and classification conflict, escalate to IPC/CSSD leadership for risk resolution. (cdc.gov)
• B. Reusable devices must be transported in closed, labeled containers to CSSD/HLD area to prevent environmental contamination.
• C. Traceability must exist (device ID, patient/case linkage when required, cycle record).

5.3.2 Airway Devices (Examples; Facility Must Maintain Itemized Matrix)

• A. Critical items (sterilization required):
  • Devices entering sterile tissue/vascular space or designated critical by IFU (e.g., certain surgical airway instruments; select invasive probes). (cdc.gov)
• B. Semi-critical items (HLD or sterilization per IFU):
  • Many reusable supraglottic airway devices (per IFU), flexible endoscopes/bronchoscopes, and airway adjuncts contacting mucous membranes. (cdc.gov)
• C. Non-critical items (LLD):
  • External monitor leads/cuffs that contact intact skin only (unless visibly contaminated; then clean/disinfect immediately).

5.3.3 Ultrasound Probes (Regional Anesthesia / Vascular Access)

• A. External probes on intact skin: clean and perform low-level disinfection between patients. (www.aium.org)
• B. Probes contacting mucous membranes or non-intact skin: perform high-level disinfection between patients; use a single-use probe cover when indicated, but probe covers do not replace required disinfection level. (www.aium.org)
• C. Use only probe-safe disinfectants per IFU; avoid chemicals that damage probe materials. (cdc.gov)

5.3.4 Ultrasound Gel and Accessories

• A. Use single-use gel packets when required by local IPC policy or when contamination risk is high.
• B. Do not “top up” refill bottles; manage per IPC policy.

5.3.5 Laryngoscopes (Blades/Handles)

• A. Reprocess per classification and IFU; treat blades as semi-critical if contacting mucosa; handles may be contaminated and require cleaning/disinfection per IFU and local practice.
• B. Where single-use devices are adopted, dispose per waste policy and do not reprocess unless the device is validated for reuse.

5.3.6 Post-Reprocessing Storage

• A. Store reprocessed devices in clean, dry, protected storage with packaging integrity maintained until use.
• B. Remove any damaged packaging from circulation and reprocess again before use.

5.3.7 Documentation

• A. CSSD/HLD records: cycle parameters, operator, date/time, lot/cycle number.
• B. Clinical area logs: device sent for reprocessing; device returned and stored.

5.4 J4 — Waste and Sharps Policy (OR / PACU / NORA)

5.4.1 General Waste Segregation

• A. Segregate waste at point of generation per facility policy (general waste, regulated infectious waste, sharps, pharmaceutical waste, chemical waste).
• B. Do not overfill waste containers; close and replace according to fill limits and workflow.

5.4.2 Sharps Safety and Sharps Containers

• A. Immediately after use, place sharps into a closable, puncture-resistant, leakproof, labeled sharps container located within arm’s reach at point of use. (cdc.gov)
• B. Do not place sharps containers on the floor; keep upright and stable. (cdc.gov)
• C. Do not recap needles unless explicitly required by a specialized procedure and performed using a safe method per institutional policy.
• D. Replace sharps containers before overfill and secure lids before transport. (cdc.gov)

5.4.3 Regulated Medical Waste Handling

• A. Store regulated medical waste in labeled, leak-proof containers and remove regularly to prevent accumulation. (cdc.gov)
• B. Transport internal waste using closed containers/carts per hospital waste pathway.

5.4.4 Pharmaceutical Waste and Controlled Substances

• A. Dispose pharmaceutical waste per pharmacy policy; never discard controlled substances in regular waste.
• B. Handle controlled drug wastage per the Controlled Drugs policy (Section H4).

5.4.5 Spills and Blood/Body Fluid Waste

• A. Manage spills immediately with PPE and hospital-approved spill kit; dispose contaminated cleaning materials as regulated waste as appropriate.
• B. Document significant spills per incident policy.

5.4.6 National/Regulatory Alignment

Waste handling and documentation shall align with national medical waste regulations applicable to the facility. (وزارة الصحة السعودية)

5.5 J5 — Isolation Case Workflow (Coordination with OR + PACU)

5.5.1 Pre-Case Planning and Communication

• A. Identify required Transmission-Based Precautions (Contact/Droplet/Airborne) in advance and communicate to OR, anesthesia, PACU, environmental services, and receiving unit. (cdc.gov)
• B. Confirm availability of appropriate PPE and the planned recovery destination (PACU isolation room vs designated area) based on facility capability and patient risk.
• C. Plan patient transport route and minimize exposure to other patients/areas.

5.5.2 Scheduling Principles

• A. Schedule infected/transmissible disease cases toward the end of the operating list when feasible, consistent with perioperative infection control expectations. (istitlaa.ncc.gov.sa)

5.5.3 OR / Procedure Room Setup (Before Patient Arrival)

• A. Minimize equipment and supplies brought into the room to essentials only.
• B. Use disposable covers/barriers for selected high-touch equipment when compatible with IFU and local policy.
• C. Confirm suction, oxygen, and monitoring readiness; ensure disinfectant supplies are available for turnover cleaning.

5.5.4 Intra-Case Conduct

• A. Maintain required PPE throughout patient contact and high-risk tasks; avoid unnecessary room entry/exit and keep doors closed as feasible. (cdc.gov)
• B. Apply safe injection practices and strict hub/port disinfection. (asahq.org)
• C. Contain contaminated items: place used airway devices and contaminated reusable equipment into closed containers for reprocessing transport.

5.5.5 Post-Case Workflow (Room Turnover and Terminal Cleaning)

• A. After patient leaves, perform enhanced cleaning/disinfection:
  • anesthesia zone between-case cleaning (J1),
  • anesthesia machine cleaning (J2),
  • room cleaning/disinfection by housekeeping per OR protocols. (istitlaa.ncc.gov.sa)
• B. Dispose waste per regulated waste pathway (J4).
• C. Remove and reprocess reusable equipment per J3.

5.5.6 PACU Recovery Workflow for Isolation Patients

• A. Apply required precautions during handover and recovery; ensure clear signage and PPE availability. (cdc.gov)
• B. Determine placement (isolation room vs designated area) based on facility policy, patient risk, and required transmission precautions; document the plan and communicate to ward/ICU before transfer. (spice.unc.edu)
• C. Continue precautions during transport from PACU to ward/ICU.

5.5.7 Documentation

• A. Record precaution type, PPE use compliance checks (as required), recovery placement decision, and terminal cleaning completion.