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Video observation to map hand contact and bacterial transmission in operating rooms

      Background

      Hand hygiene (HH) is considered a primary intervention to avoid transmission of bacteria in health care settings and to prevent health care-associated infections. Despite efforts to decrease the incidence of health care-associated infections by improving HH, HH compliance rates vary widely depending on the hospital environment.

      Methods

      We used intraoperative video observation to map temporal patterns of anesthesia provider hand contact with anesthesia work environment (AWE) surfaces and to assess HH compliance. Serial bacterial cultures of high contact objects were subsequently used to characterize bacterial transmission over time.

      Results

      Using World Health Organization criteria, we found a large number of HH opportunities and a low rate of HH compliance by anesthesia providers (mean, 2.9%). We observed an inverse correlation between provider hand hygiene compliance during induction and emergence from anesthesia (3.2% and 4.1%, respectively) and the magnitude of AWE surface contamination (103 and 147 CFU, respectively) at these time points. We found no correlation between frequency of hand contact with the AWE and bacterial contamination.

      Conclusions

      Compliance with current HH recommendations by anesthesia providers is not feasible. However, there does appear to be a correlation between HH compliance rates and bacterial contamination of the AWE, an observation that should stimulate further work to design new methods for control of bacterial transmission in operating rooms.

      Key Words

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      References

        • Klevens R.M.
        • Edwards J.R.
        • Richards C.L.
        • Horan T.C.
        • Gaynes R.P.
        • Pollock D.A.
        • et al.
        Estimating health care-associated infections and deaths in US hospitals, 2002.
        Public Health Rep. 2007; 122: 160
        • Stulberg J.J.
        • Delaney C.P.
        • Neuhauser D.V.
        • Aron D.C.
        • Fu P.
        • Koroukian S.M.
        Adherence to surgical care improvement project measures and the association with postoperative infections.
        JAMA. 2010; 303: 2479-2485
        • Edwards J.R.
        • Peterson K.D.
        • Mu Y.
        • Banerjee S.
        • Allen-Bridson K.
        • Morell G.
        • et al.
        National Heathcare Safety Network (NHSN) report: data summary for 2006 through 2008.
        Am J Infect Control. 2009; 37: 783-805
        • Stone P.W.
        • Larson E.
        • Kawar L.N.
        A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000.
        Am J Infect Control. 2002; 30: 145-152
        • Sessler D.I.
        Nonpharmacologic prevention of surgical wound infection.
        Anesthesiol Clinic. 2006; 24: 279-297
        • Loftus R.W.
        • Koff M.D.
        • Burchman C.C.
        • Schwartzman J.D.
        • Thorum V.
        • Read M.E.
        • et al.
        Transmission of pathogenic bacterial organisms in the anesthesia work area.
        Anesthesiology. 2008; 109: 399-407
        • Koff M.D.
        • Loftus R.W.
        • Burchman C.A.
        • Hogan D.A.
        • Beach M.L.
        Microbial contamination in the anesthesia workspace: are we as clean as we think?.
        Anesthesiology. 2007; 107: A1788
        • Koff M.D.
        • Loftus R.W.
        • Burchman C.C.
        • Schwartzman J.D.
        • Read M.E.
        • Henry E.S.
        • et al.
        Reduction in intraoperative bacterial contamination of peripheral intravenous tubing through the use of a novel device.
        Anesthesiology. 2009; 110: 978-985
        • Loftus R.W.
        • Muffly M.K.
        • Brown J.R.
        • Beach M.L.
        • Koff M.D.
        • Corwin H.L.
        • et al.
        Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission.
        Anesthes Analg. 2001; 112: 98-105
        • Loftus R.W.
        • Brown J.R.
        • Koff M.D.
        • Reddy S.
        • Heard S.O.
        • Patel H.M.
        • et al.
        Multiple reservoirs contribute to intraoperative bacterial transmission.
        Anesthes Analg. 2012; 114: 1236-1248
        • Edmiston Jr., C.E.
        • Seabrook G.R.
        • Cambria R.A.
        • Brown K.R.
        • Lewis B.D.
        • Sommers J.R.
        • et al.
        Molecular epidemiology of microbial contamination in the operating room environment: is there a risk for infection?.
        Surgery. 2005; 138: 573-579
        • Boyce J.M.
        • Pittet D.
        Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association of Professionals in Infection Control/Infectious Diseases Society of America.
        MMWR Recomm Rep. 2002; 51: 1-45
        • Drygen G.E.
        Uncleaned anesthesia equipment.
        JAMA. 1975; 233: 1297-1298
        • Biddle C.
        • Shah J.
        Quantification of anesthesia providers' hand hygiene in a busy metropolitan operating room: what would Semmelweis think?.
        Am J Infect Control. 2012; 40: 756-759