Hand Hygiene Compliance Infeasible for Anesthesia Providers

Marcia Frellick

July 03, 2014

Anesthesia providers had high numbers of hand hygiene (HH) opportunities in the operating room per hour, but low levels of HH compliance, according to a new study. Compliance was lowest during the first and last 20-minute periods in the operating room.

"Complete compliance with HH practice as recommended by World Health Organization guidelines would have consumed more than the 60 minutes available in each hour of anesthesia time, a fact that identifies a need to create more practical — but still effective — methods of controlling bacterial transmission in [anesthesia work environments]," the authors write.

John Rowlands, MD, from the Department of Anesthesiology at Dartmouth-Hitchcock, Medical Center, Lebanon, New Hampshire, and colleagues mapped patterns of anesthesia provider hand contact with anesthesia work environment surfaces to assess HH compliance. Results of the study were published in the July issue of the American Journal of Infection Control.

"Infections that occur after elective surgery account for a significant proportion of all [healthcare-associated infections]," the authors write.

The researchers followed World Health Organization hand hygiene criteria, which include 5 moments for hand washing to reduce the risk for healthcare-associated infection: before touching a patient, before a clean procedure, after exposure to body fluids, after touching a patient, and after touching a patient's surroundings.

In this study, researchers observed an average of 149 HH opportunities per hour of anesthesia time in randomly selected operating rooms where surgeries including general anesthesia were scheduled. The mean HH compliance rates were 2.9%; rates were lowest during induction (3.2%) and emergence from anesthesia (4.1%). The low HH compliance rates at case start and case end corresponded with sharp peaks in bacterial contamination of the 20 most frequently touched objects during these same periods.

The top 5 items most commonly touched, the study says, were patient bed (77 touches per hour), pen (63), anesthesia cart second drawer handle (55), anesthesia chair (48), and right monitor screen button (46).

Providers were aware they were being videotaped by mounted cameras but were blinded to observational end points.

The authors point out that total compliance with the HH guidelines, which are established for non–operating room environments, would consume more than the 60 minutes in each hour of anesthesia time. It is particularly impractical, the authors note, to access a wall dispenser during the rapidly changing induction and emergent phases, which heightens the need for more practical solutions for controlling bacterial transmission when anesthesia is being administered.

Each operating room had both a wall-mounted, alcohol-based gel dispenser within 3 feet of the provider and a 70% ethanol liquid dispenser on the anesthesia cart.

The authors say the correlation between HH compliance rates and bacterial contamination of the anesthesia work area calls for further work to design new methods for control of bacterial transmission in operating rooms.

"This work adds to the body of evidence pertaining to intraoperative bacterial transmission because it identifies targets for improved frequency and quality of environmental cleaning as well as important periods for HH compliance, namely induction and emergence from general anesthesia," the authors conclude.

The authors have disclosed no relevant financial relationships.

Am J Infect Control. 2014;42:698-701. Full text

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