Highlights
- •Defining the anesthetists' role as a vector in pathogen dispersion is important.
- •Anesthetists' glove use greatly influences contamination of their workstation.
- •Intravenous access stopcocks were frequently contaminated regardless of gloving technique.
- •Routine cleaning failed in part because of workstation design complexity.
Background
The role of anesthesia providers in dispersing potentially pathogenic material from
one patient to another during intraoperative care needs further study. In this study
we aimed (1) to quantify the dispersion of a surrogate pathogen from a simulated patient's
mouth to the anesthesia workstation during routine anesthetic induction, (2) to test
the hypothesis that there would be fewer contamination sites by providers who used
a double-gloving technique, and (3) to examine the effectiveness of between-case anesthesia
apparatus disinfection.
Methods
Twenty subjects were randomized to a single pair of gloves group (group 1) or a double-gloved
group (group 2) and completed a simulated general anesthesia induction, completing
a standardized set of interventions. Dispersion of a surrogate pathogen dye placed
in the oral cavity of the simulated patient was tracked by a blinded observer and
photography. Standard cleaning of the workstation was performed, and residual dye
was quantified. Group performance was plotted using regression analysis and rate of
contamination compared using parametric statistics.
Results
Group 1 contaminated an average of 16.0 (SEM = 0.89) sites compared with group 2,
who contaminated an average of 7.6 (SEM = 0.85). The cart drawers, gas flow dials,
medication vials, and ventilator controls were significantly contaminated by group
1, but not by group 2 (P < .05 in all cases). There were similar rates of contamination in both groups for
the airway equipment, breathing system, intravenous access ports, and the roll of
tape used to secure the endotracheal tube. Once the airway management phase of the
induction ended, new site contamination continued at a high rate in group 1 but not
group 2.
Conclusions
A double-gloving technique was associated with less spread of an oral inoculum to
the workstation but was not uniformly protective. Between-case cleaning was ineffective
in removing the contaminant, indicating that biologic material from one patient may
be present when subsequent patients are cared for. This suggests risks for the current
patient (eg, skin or oral site transfer to an intravenous site) and also may place
future patients at risk. Importantly, using models that simulate actual clinical events
can inform clinical practice and decipher challenging areas of ergonomics.
Key Words
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Article Info
Publication History
Published online: March 31, 2016
Footnotes
Conflicts of Interest: None to report.
Identification
Copyright
© 2016 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
