Heater–cooler devices are used during cardiothoracic surgeries, as well as other medical and surgical procedures to warm or cool a patient to optimize medical care and improve patient outcomes. These devices include water tanks that provide temperature-controlled water to external heat exchangers or warming/cooling blankets through closed circuits. Although the water in the circuits does not come into direct contact with the patient, there is the potential for contaminated water to enter other parts of the device or be aerosolized through the device’s exhaust vent into the environment and to the patient, according to the FDA.
- Strictly adhere to the cleaning and disinfecting instructions provided in the manufacturer’s device labeling. Ensure you have the most current version of the manufacturer’s instructions for use readily available to promote adherence.
- Do not use tap water to rinse, fill, refill or top off water tanks, as this may introduce NTM organisms. Use only sterile water or water that has been passed through a filter of less than or equal to 0.22 μm.
- When making ice needed for patient cooling during surgical procedures, use only sterile water or water that has been passed through a filter of less than or equal to 0.22 μm. Deionized water and sterile water created through reverse osmosis are not recommended because it may corrode metal components of the system.
- Direct the heater–cooler’s vent exhaust away from the surgical field to mitigate the risk of aerosolizing heater–cooler tank water into the sterile field and exposing the patient.
- Establish regular cleaning, disinfection and maintenance schedules for heater–cooler devices.
- Develop and follow a comprehensive quality control program for maintenance, cleaning and disinfection of heater–cooler devices.
- Immediately remove from service heater–cooler devices that show discoloration or cloudiness in the fluid lines/circuits, which may indicate bacterial growth. Consult the hospital infection control officials to perform the appropriate follow-up measures, and report events of device contamination to the manufacturer.
- Consider performing environmental, air, and water sampling and monitoring if heater–cooler contamination is suspected.
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