Safety and Infection Control
Standard precautions
Every patient is a potential source of bloodborne and airborne pathogens. Perform hand hygiene before and after contact, wear gloves when handling mouthpieces, nasal clips, or blood-contaminated items, and use eye and face protection when splash is possible. Patients with suspected or confirmed tuberculosis, influenza, or COVID-19 should be tested in a negative-pressure room or a well-ventilated space with HEPA filtration where available, and staff should wear respiratory protection. Use single-use in-line filters where the device allows, and never reuse a mouthpiece.
Reprocessing
Classify equipment by Spaulding categories: items contacting mucous membranes or broken skin need high-level disinfection at minimum, and items entering sterile tissue require sterilization. Disassemble and clean valves and reusable sensors before disinfection, and honor the required contact time. Alcohol wipes suit low-touch surfaces but are not adequate high-level disinfection. Follow the manufacturer validated method; a common exam error is choosing a disinfectant that damages the sensor.
Emergencies and environment
Keep oxygen, a bag-valve mask, albuterol, epinephrine, and an AED accessible. Watch for syncope after forced maneuvers, bronchospasm after methacholine, and desaturation during DLCO or exercise testing. Seat patients, remove loose dentures, and prevent falls. Follow oxygen storage rules and keep aerosols away from open flames.
Worked example
After a methacholine challenge the patient wheezes with SpO2 of 88 percent. Stop testing, give oxygen and a bronchodilator per protocol, and do not discharge until symptoms and saturation recover.