Easing the Pain:Infection Control and Anesthesia

Susan A. Dolan, RN, MS, CIC Children’s Hospital Colorado

Robin Stackhouse, MDUniversity of California, San Francisco

APIC Annual Education Conference June 7-9 2014Anaheim, CA

ObjectiveObjective Identify 3 areas where there is a gap

between Anesthesia’s daily practice and infection prevention & control

Utilize evidence based information to address gaps in Anesthesia IP&C

Initiate the use of an IP&C assessment tool with Anesthesia team at your facility

Anesthesia OR Work Environment Anesthesia OR Work Environment South BaySouth Bay

Hand Hygiene-Expectations

Prior to first interacting with patient Prior to donning sterile gloves After any invasive procedure After manipulation of the airway

(intubation, suctioning) After touching the patient for surgical

positioning After glove removal After retrieving a soiled or dropped

item from OR floorBiddle C. Shah J. AJIC 2012:40(8):756-9

Results: 8,000 HH opportunities were observed Aggregate failure rate was 82% with a

range of 64% to 93% by provider group

Conclusions:

HH was very poor among anesthesia providers.

This intrinsic HH failure rate creates a great opportunity for horizontal and vertical vectors for nosocomial infection

Biddle C. Shah J. AJIC 2012:40(8):756-9

Contact of Surfaces by Contact of Surfaces by AnesthesiologistAnesthesiologist

Per hourMunoz-Prize, Infect Control Hosp Epidemiology 2014

Hand hygiene by Hand hygiene by AnesthesiologistAnesthesiologist

Per hourMunoz-Prize, Infect Control Hosp Epidemiology 2014

Major categories of HH failure

Moving between patients during pre-op Before, during and after placing nerve

blocks After any invasive procedure Soiled gloves left on after airway

manipulation After touching the patient for surgical

positioning After picking up item from floor (pen,

tape) and using it.

Biddle C. Shah J. AJIC 2012:40(8):756-9

Work flow issues:

Intubation….. Adjusting gases and vent settings

Double glove?Remove outer gloves and not perform HHWear gloves for identified “dirty environment”?

Where to go from here?Where to go from here?

Collaborative Approach Collaborative Approach

The Inside View:The Inside View: Anesthesiology teamAnesthesiology team Surgical team Surgical team

The Outside View:The Outside View: Infection Prevention teamInfection Prevention team

Share Anesthesia IP&C Assessment Share Anesthesia IP&C Assessment ToolTool

P&P Hand Hygiene / Glove use PPE / Attire Environment (clean vs. dirty) OR Attire Safe injection practices and medications IV supplies and therapy Respiratory care procedures / equipment Disinfection Exposure Management

Recommendations / SuggestionsRecommendations / Suggestions1. Clearly define “clean” and “dirty” areas during a case: “Clean”: medication prep area / IV access / (intubation) “Dirty”: keyboards / anesthesia machine / trash containers/ floor.2. Perform hand hygiene when changing from “dirty” to “clean”.2. Have alcohol gel dispensers accessible3. Perform HH as you enter and exit the OR4. Perform HH prior to donning sterile gloves6. Before accessing clean supplies, med prep or administration7. Double glove during intubation? remove the outer set immediately after intubation (1 study found contamination of intraoperative environment was dramatically reduced).

see abstract online in Anesthesia & Analgesia May 15

Thank you!Thank you!