Treatment for severe cases of Covid-19 often involves supplemental oxygen therapy or ventilation. Consequently, equipment such as regulators, flowmeters and cylinder valves have been in peak demand across hospital and homecare settings worldwide.
In the course of delivering such care, medical devices and instruments will come into contact with patients infected with coronavirus. In order to prevent potential patient-to-patient transfer of Covid, reusable medical devices must be sterilized or thoroughly disinfected between uses.
Understandably, medical professionals are keen to ensure that they are following effective cleaning and disinfecting regimes and actively managing the risk of infection. In the United States, such advice is stipulated by the US Center for Disease Control & Prevention (CDC) which has a list of EPA-registered disinfectants that meet the criteria for Covid-19.
Most disinfectants, however, are only effective against 99.9% of bacteria – leaving a sizable chance that organisms remain and the virus is not eliminated. At GCE, we recommend a two-step cleaning process for medical regulators and valves that will ensure the integrity of equipment inside and out.
Firstly, we advise the wearing of PPE – such as a face shield, mask and disposable gloves – to mitigate any residual risk of contamination. Secondly, use a good, premium dish soap with warm water and a scrubbing brush to clean the equipment. Rinse and repeat.
Ready-to-use disinfectants should be applied using mists and wipes where possible. Products with short contact times are preferred because they are less likely to degrade the elastomer and polymer parts in the equipment. GCE also advises against the use of liquid pesticides, which are often too aggressive.
Equipment such as demand valves, used to administer gas mixtures for pain relief or therapy, can come into direct contact with the patient and can therefore be internally contaminated with a patients’ fluids. To decontaminate these items, it’s recommended that they are fully cleaned using an enzymatic detergent and then disinfected – as per the manufacturers’ instructions for use.
New risks are presented by Covid-19 for medical cylinder packages. Such risks include potential external contamination on returned cylinder packages, and also potentially internal contamination within the cylinder package. Such internal contamination can arise in one of two primary ways explored below.
1. Inadvertent projection of external package contamination into the cylinder during the next gas fill cycle Cleanliness of the filling port area of any valve is of critical importance. If the next fill-process ‘blows’ contamination into the cylinder along with the medical gas, a critical cross-contamination risk for the next patient exists. As a first step, any cylinders returning to a filling station without port protection need to be segregated and assessed for special, pre-fill cleaning.
Technicians should also fully clean fill adapters between every cylinder fill cycle and install fill port covers immediately after the filling process. For VIPR valves with close-fitting guards, adequate cleaning should be possible without removing the guard. However, where more open access to the valve is available, GCE recommends cleaning the entire valve body with suitable wipes.
2. Backflow from downstream patient-contact equipment and also atmospheric back contamination (which may contain Covid-19), whilst the cylinder is in an empty, de-pressurized state at the end of use
Incidents caused by backflow of contaminants into cylinders are a longstanding problem and an area of increased concern with the recent Covid outbreak. In many valve designs, protection of the cylinder interior can be achieved by using devices to retain a small amount of pressure within the cylinder once it is notionally empty. This will prevent any backflow from downstream equipment into the cylinder throughout its life.
These devices, referred to as a Residual Pressure Device (RPD) or Residual Pressure Valve (RPV), have been available to healthcare customers for many years. However, the compact body design of the Pin Index (Post) Medical Valve, used worldwide, has presented previously insurmountable challenges. The foremost of these being that the RPD couldn’t be physically designed and manufactured into the valve body.
GCE has successfully miniaturized the RPV components and developed a new range of pin index valves for all medical gases including oxygen, nitrous oxide, entonox mixtures, carbon dioxide, medical air and helium/heliox. These valves are available for all standard cylinder connections with inlet pressures up to 3,000 psi (200 bar).
In many ways, GCE’s innovative and unique Pin Index (Post) medical valve with RPV, and the timing of its introduction, is a mini miracle. For gas companies, healthcare professionals and technicians looking to manage Covid contamination issues with medical equipment, they can be a saving grace. Finally, they enable the long-understood benefits of valves with RPD for protection against the highest-risk internal cylinder contamination to be delivered in a compact valve design.
Delivering eight individual benefits in one RPD package, together we can ensure the cylinder package interior remains clean and at the same time extend valve service life. By protecting the cylinder’s integrity during a period when all cylinder packages worldwide are working harder than ever, we stand a greater chance of overcoming the lingering effects of Covid.