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Gibbons S, Dexter F, Loftus RW, Brown JR, Wanta BT, Charnin JE. The relative efficacy of multiple syringe tip disinfection techniques against virulent staphylococcus contamination. J Hosp Infect 2024; 145:142-147. [PMID: 38272124 DOI: 10.1016/j.jhin.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/19/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND A recent study confirmed significant contamination of syringe tips following routine anaesthesia practice of at least 6 h in duration. AIM We assessed the relative efficacy of clinically relevant syringe tip disinfection techniques following contamination with the hyper transmissible and more pathogenic Staphylococcus aureus sequence type 5 (S. aureus ST5) strain characteristic associated with increased strength of biofilm formation and greater desiccation tolerance. METHODS Syringe tips (N=40) contaminated with S. aureus ST5 were randomized to 70% isopropyl pads with 10 or 60 s of drying time, scrubbing alcohol disinfection caps with 10 or 60 s of dwell time, or to non-scrubbing alcohol disinfection caps with 60 s of dwell time. The primary outcome was residual 24-h colony forming units (cfu) >10. RESULTS Scrubbing disinfection caps were more effective than alcohol pads (25% (12/48) <10 cfu for scrubbing caps (10- or 60-s dwell times) vs 0% (0/48) <10 cfu for alcohol pads (10 or 60 s of drying time), Holm-Sidak adjusted P=0.0016). Scrubbing disinfection caps were more effective than non-scrubbing alcohol disinfection caps (25% (12/48) <10 cfu for scrubbing alcohol caps (10- or 60-s dwell times) vs 2% (1/48) for non-scrubbing alcohol caps (60-s dwell time), adjusted P=0.0087). CONCLUSIONS Scrubbing alcohol caps are more effective than alcohol pads or non-scrubbing disinfecting caps for microbial reduction of syringe tips contaminated with the more pathogenic S. aureus ST5.
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Affiliation(s)
- S Gibbons
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| | - F Dexter
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| | - R W Loftus
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - J R Brown
- Dartmouth Center for Implementation Science, Departments of Epidemiology Biomedical Data Science, Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - B T Wanta
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - J E Charnin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
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Zucco L, Chen MJ, Levy N, Obeidat SS, Needham MJ, Hyatt A, Keane JR, Pollard RJ, Mitchell JD, Ramachandran SK. Just-in-Time In Situ Simulation Training as a Preparedness Measure for the Perioperative Care of COVID-19 Patients. Simul Healthc 2023; 18:90-99. [PMID: 35148284 PMCID: PMC10081926 DOI: 10.1097/sih.0000000000000635] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Routine workflows were redesigned during the first surge of the COVID-19 pandemic to standardize perioperative management of patients and minimize the risk of viral exposure and transmission to staff members. Just-in-time (JIT), in situ simulation training was adopted to implement urgent change, the value of which in a public health crisis has not previously been explored. METHODS Implementation of workflow changes in the setting of the COVID-19 pandemic was accomplished through JIT, in situ simulation training, delivered over a period of 3 weeks to participants from anesthesia, nursing, and surgery, within our healthcare network. The perceived value of this training method was assessed using a postsimulation training survey, composed of Likert scale assessments and free-text responses. The impact on change in practice was assessed by measuring compliance with new COVID-19 workflows for cases of confirmed or suspected COVID-19 managed in the operating room, between March and August 2020. RESULTS Postsimulation survey responses collected from 110 of 428 participants (25.7%) demonstrated significant positive shifts along the Likert scale on perceived knowledge of new workflow processes, comfort in adopting them in practice and probability that training would have an impact on future practice (all P s < 0.001). Free-text responses reflected appreciation for the training being timely, hands-on, and interprofessional. Compliance with new COVID workflows protocols in practice was 95% (121 of 127 cases) and was associated with lower than expected healthcare worker test positive rates (<1%) within the network during this same period. CONCLUSIONS These findings support JIT, in situ simulation training as a preparedness measure for the perioperative care of COVID-19 patients and demonstrate the value of this approach during public health crises.
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Frödin M, Rogmark C, Nellgård B, Gillespie BM, Wikström E, Andersson AE. Interactive Interventions Can Improve Hand Hygiene and Aseptic Techniques During Perioperative Care-Experience From the "Safe Hands" Project. J Perianesth Nurs 2023; 38:284-290. [PMID: 36319520 DOI: 10.1016/j.jopan.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This paper evaluates a theory-driven, interactive hand hygiene (HH) intervention, the Safe Hands project, based on theories of organizational learning and culture including leadership support, dialogue and co-creation. DESIGN This prospective quasi-experimental study used unobtrusive overt observations to evaluate adherence to HH recommendations after implementing an infection-prevention intervention. METHODS The primary outcome was differences in HH practices "Before aseptic/clean procedure" (WHO moment 2), "After body fluid exposure risk" (WHO moment 3) and performance of aseptic techniques. One operating room (OR) department served as the study hospital and the other as the control hospital, both at Swedish university hospitals. Adherence to HH guidelines was measured 4 times during 2015 to 2017. FINDINGS The intervention site displayed a significant improvement in adherence to HH guidelines and aseptic techniques. WHO 2; from 23.8% to 36.2%, (P = .014), WHO 3; from 22.2% to 42.3%, (P = .002), and aseptic techniques; from 17.5% to 31.6%, (P = .003). No changes in adherence were identified at the control site. The use of contaminated gloves decreased post intervention at the study operating department. CONCLUSIONS This study shows that implementing tailored interventions that are underpinned by theories from organizational learning and culture can improve adherence to hand hygiene in a complex setting as the OR up to 6 months post-intervention. The interprofessional co-creation of standards operating procedures addressing specific care procedures and emphasizing the importance of aseptic techniques can be an acceptable and feasible way to reduce the risks of contaminating medical devices and patients during perioperative care.
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Affiliation(s)
- Maria Frödin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden; Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Västra Götalandregionen, Sweden.
| | - Cecilia Rogmark
- Department of Orthopedics Malmö, Lund University, Skane University Hospital, Lund, Skane, Sweden; The Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Västra Götalandregionen, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Västra Götalandregionen, Sweden
| | - Brigid M Gillespie
- NMHRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Griffith, Queensland, Australia; Health Service, Gold Coast University Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden
| | - Annette E Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden
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Schnetzinger M, Assadian O, Markstaller K, Klein KU. [Infection prevention in the operating theater: practice-oriented recommendations for anesthesiologists]. DIE ANAESTHESIOLOGIE 2023; 72:121-127. [PMID: 36449055 PMCID: PMC9892077 DOI: 10.1007/s00101-022-01239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/02/2022]
Abstract
This article is intended to provide clinically working anesthesiologists with a practice-oriented overview of selected important current guidelines and recommendations pertaining to intraoperative prevention of infection. The contents of this article are based on the guidelines or recommendation of the World Health Organization (WHO) and the Association of the Scientific Medical Societies in Germany (AWMF) as well as the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute (RKI). The authors' objective is to foster and support the standard of infection prevention and control in the operating theater by optimizing the standard of hygiene in daily practice to reduce the number of perioperative infections.
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Affiliation(s)
- Maximilian Schnetzinger
- grid.22937.3d0000 0000 9259 8492Univ.-Klinik für Anästhesie, Allgemeine Intensivmedizin und Schmerztherapie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1190 Wien, Österreich
| | - Ojan Assadian
- Ärztliche Direktion, Landesklinikum Wiener Neustadt, Corvinusring 3–5, 2700 Wiener Neustadt, Österreich
| | - Klaus Markstaller
- grid.22937.3d0000 0000 9259 8492Univ.-Klinik für Anästhesie, Allgemeine Intensivmedizin und Schmerztherapie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1190 Wien, Österreich
| | - Klaus Ulrich Klein
- grid.22937.3d0000 0000 9259 8492Univ.-Klinik für Anästhesie, Allgemeine Intensivmedizin und Schmerztherapie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1190 Wien, Österreich
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Simmons CG, Hennigan AW, Loyd JM, Loftus RW, Sharma A. Patient Safety in Anesthesia: Hand Hygiene and Perioperative Infection Control. CURRENT ANESTHESIOLOGY REPORTS 2022; 12:493-500. [PMID: 36345323 PMCID: PMC9631600 DOI: 10.1007/s40140-022-00545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
Purpose of Review This review highlights the importance of the anesthesia team in minimizing perioperative infection risks and prevention of surgical site infection. Due to the immense financial and patient care burden that results from perioperative infection, a foundational knowledge in preventive measures is essential. Recent Findings Perioperative infection control, the role of the anesthesia team in reducing infection risk, and more specifically the outsized importance of hand hygiene in this space have become increasingly apparent. Maintenance of workspace cleanliness along with hand hygiene forms the cornerstone of preventing microbial transmission. Unfortunately, improvements around perioperative infection control are lacking. Summary The importance of the anesthesia team in maintaining proper hand hygiene, a clean work environment, and appropriate patient conditions to minimize risk of perioperative infection cannot be overstated. Poor clinical outcomes, economic burden, and external pressure from payers highlight the need for anesthesia providers to have an up-to-date knowledge of best practices in this area. In this article, we will review the current recommendations for hand hygiene practices and perioperative infection prevention.
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Affiliation(s)
- Colby G. Simmons
- Department of Anesthesiology, University of Colorado– Anschutz Medical Campus, Mail Stop B113, Leprino Building, 12401 E 17th Ave. Leprino Bldg #734, Aurora, CO 80045 USA
| | - Andrew W. Hennigan
- Department of Anesthesiology, University of Colorado– Anschutz Medical Campus, Mail Stop B113, Leprino Building, 12401 E 17th Ave. Leprino Bldg #734, Aurora, CO 80045 USA
| | - Jacob M. Loyd
- Department of Anesthesiology, University of Colorado– Anschutz Medical Campus, Mail Stop B113, Leprino Building, 12401 E 17th Ave. Leprino Bldg #734, Aurora, CO 80045 USA
| | - Randy W. Loftus
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, 6618 John Colloton Pavillion, Iowa City, IA 52242 USA
| | - Archit Sharma
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, 6618 John Colloton Pavillion, Iowa City, IA 52242 USA
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Muacevic A, Adler JR, Dwivedi S, Tibbetts RJ, Srinivasan SK. A Microbiological Assay of Common Operating Room (OR) Tapes: Developing a Culture for Patient Safety. Cureus 2022; 14:e31919. [PMID: 36579258 PMCID: PMC9792278 DOI: 10.7759/cureus.31919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There are no existing practices or methods to ensure cleanliness, sterility, or prevent cross-contamination when it comes to common operating room (OR) tape. The authors hypothesized that adhesive tapes used by anesthesia providers in ORs and off-site surgical areas might be colonized by microorganisms and that culturing these tape rolls would reveal significant monomicrobial and polymicrobial contamination. Material and Methods: The primary objective of this observational cohort study was to report and compare contamination rate including polymicrobial contamination rate between tape specimens collected from storage site and specimen from the ORs, off-sites, and after use on a patient. The outcome measures were the culture reports of the adhesive tapes. The authors then designed an intervention that integrated anesthesia providers' hand hygiene and maintenance of a barrier between the OR tapes and OR surfaces. RESULTS The authors reported gross contamination and cross-contamination among the OR off-site tapes. The contamination rates reported for tapes from OR, off-site specimens, and patient specimens were 68.2%,63.2%, and 100%, respectively. The authors again cultured adhesive tapes after the intervention and reported improved outcomes. CONCLUSIONS The current quality improvement (QI) project identified the potential for OR tapes to serve as microbial vectors. The authors advocate environmental decontamination and anesthesia providers' hand hygiene in parallel as a part of routine anesthesia care in their practice and agree that the endotracheal tubes (ETTs) and orogastric or nasogastric tubes should be pre-packaged with single-use tape, which can be used for securing devices.
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Segal E, Bar Yosef S, Axel A, Keller N, Shlaeffer F, Amir A, Efroni G, Haberman Y. Outbreak of Sepsis Following Surgery: Utilizing 16S RNA Sequencing To Detect the Source of Infection. Cureus 2022; 14:e22487. [PMID: 35371778 PMCID: PMC8944214 DOI: 10.7759/cureus.22487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Nosocomial infections are a significant health concern. Following surgery, infections are most commonly associated with the surgical site, yet there are other potential sources for infections after surgical interventions. Identification of the source of infections can be very challenging. Methodology An outbreak of postoperative infections following surgery led to intensive care unit (ICU) admission of patients immediately after the surgical procedure. The blood cultures of two patients were positive for Citrobacter freundii. The only connection between all cases was the anesthesiologist. An epidemiological inquiry could not definitively identify the source of the outbreak. Therefore, we utilized an RNA sequencing technique to evaluate the microbiome of the anesthesiologist and compared the results to bacteria cultured from the bloodstream of the two patients. Results The anesthesiologist’s microbiome contained amplicons that were identical to those of the bacteria in the patient’s bloodstream. Because Citrobacter freundii is an uncommon source of bloodstream infections, and in the normal human microbiome, the results establish the source of a cluster of infections to the anesthesiologist. Conclusions In cases of nosocomial infections, when conventional microbiological techniques do not clearly establish the source of the infection, using 16S RNA sequencing should be considered.
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Wang ML, Hung MH, Hsu HH, Cheng YJ, Chen JS. Non-intubated Thoracoscopic Surgery to Minimize Contamination From Airway Secretions During the COVID-19 Pandemic. Front Surg 2022; 9:818824. [PMID: 35252335 PMCID: PMC8894440 DOI: 10.3389/fsurg.2022.818824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background General anesthesia and tracheal intubation potentially pose a high risk to health care workers (HCWs) managing surgical patients during the coronavirus disease 2019 (COVID-19) pandemic. Non-intubated anesthesia is a rational way of managing patients undergoing thoracoscopic surgery that avoids tracheal intubation and minimizes the aerosols generated during airway instrumentation. The purpose of this study was to determine whether non-intubated anesthesia in combination with a face mask is safe and feasible in patients undergoing thoracoscopic surgery. Methods A total of 18 patients who underwent non-intubated thoracoscopic surgery with a face mask during the perioperative period between March 9, 2020 and April 6, 2020 were included. The main outcomes were anesthetic management and postoperative results. Results The 18 patients had a mean age of 64 years and a body mass index of 22.9 kg/m2. All patients wore a mask during induction of anesthesia and throughout surgery. Three patients underwent lobectomy, four segmentectomy, ten wedge resection, and one underwent anterior mediastinal tumor resection. No patient developed cough or vomiting during the perioperative period. All patients were transferred to the postoperative recovery unit within 15 min of the end of surgery (average 7.2 min). No patient required conversion to tracheal intubation or conversion to thoracotomy. Conclusion Non-intubated anesthesia with a mask was safe and feasible in patients undergoing thoracoscopic surgery. Avoidance of intubated general anesthesia and use of a lung separation device may reduce the risk to HCWs of contamination by airway secretions, thereby conserving personal protective equipment, especially during the COVID-19 pandemic.
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Affiliation(s)
- Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- *Correspondence: Jin-Shing Chen
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Major AL, Jumaniyazov K, Yusupova S, Jabbarov R, Saidmamatov O, Mayboroda-Major I. Laparoscopy in Gynecologic and Abdominal Surgery in Regional (Spinal, Peridural) Anesthesia, the Utility of the Technique during COVID-19 Pandemic. MEDICINES (BASEL, SWITZERLAND) 2021; 8:60. [PMID: 34677489 PMCID: PMC8541053 DOI: 10.3390/medicines8100060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND laparoscopic surgery is mainly performed in general anesthesia. Symptomatic patients infected with COVID-19 needing surgery are however at higher risk for COVID-19 complications in general anesthesia than in regional anesthesia. Even so, Covid transfection is a hazard to medical personnel during the intubation procedure and treatment drugs may be in shortage during a pandemic. Recovery and hospital stay are also shorter after laparoscopy. Laparoscopy performed in regional anesthesia may have several advantages in limiting Covid. METHODS international literature on the risk of COVID-19 complications development was searched. 3 topics concerning laparoscopic surgery were reviewed: (1) Achievements in laparoscopy; (2) Advantages of regional anesthesia compared to general anesthesia; (3) Feasibility to perform laparoscopy in regional anesthesia in COVID-19 pandemic. The authors reviewed abstracts and full-text articles concerning laparoscopic surgery, gynecology, anesthesia and COVID-19. Studies published in PubMed, Embase, Cochrane Library and found in Google Scholar before 1st FEB, 2021 were retrieved and analyzed. RESULTS a total of 83 studies were found, all of them written in English. 17 studies could be found in gynecology and in general surgery about laparoscopy with regional anesthesia. In Covid time only one study compared laparoscopic surgery in general anesthesia to laparotomy and another study laparotomy in general anesthesia to regional anesthesia. Laparoscopy showed no disadvantage compared to laparotomy in Covid pandemic and in another study laparotomy in general anesthesia was associated with higher mortality and more pulmonary complications. Trendelenburg position can be a threat if used by inexperienced personnel and can induce unintended anesthesia of breathing organs. On the other hand Trendelenburg position has advantages for cardiovascular and pulmonary functions. Pneumoperitoneum of low CO2 pressure is well tolerated by patients. CONCLUSIONS elective surgery should be postponed in symptomatic Covid patients. In inevitable emergency surgery intubation anesthesia in COVID-19 pandemic is as far as possible to be avoided. In COVID-19 pandemic, regional anesthesia is the preferred choice. The optimum may be the combination of laparoscopic surgery with regional anesthesia. Reducing the pneumoperitoneum is a good compromise for the comfort of patients and surgeons. A special case is gynecology, which needs to be performed in Trendelenburg position to free pelvic organs.
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Affiliation(s)
- Attila Louis Major
- Femina Gynecology Centre, CH-1205 Geneva, Switzerland
- Department of Obstetrics & Gynecology, University of Fribourg, CH-1700 Fribourg, Switzerland
| | - Kudrat Jumaniyazov
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Shahnoza Yusupova
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Ruslan Jabbarov
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Olimjon Saidmamatov
- Faculty of Tourism and Economics, Urgench State University, Urgench 220100, Uzbekistan
| | - Ivanna Mayboroda-Major
- Department of Gynecology and Obstetrics, University Hospital of Geneva, CH-1205 Geneva, Switzerland
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Reynier T, Berahou M, Albaladejo P, Beloeil H. Moving towards green anaesthesia: Are patient safety and environmentally friendly practices compatible? A focus on single-use devices. Anaesth Crit Care Pain Med 2021; 40:100907. [PMID: 34153533 DOI: 10.1016/j.accpm.2021.100907] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Discuss if the use of disposable or reusable medical devices leads to a difference in terms of hospital-acquired infection or bacterial contamination. Determine which solution is less expensive and has less environmental impact in terms of carbon footprint, energy and water consumption and amount of waste. METHODS We carried out a narrative review. Articles published in English and French from January 2000 to April 2020 were identified from PubMed. RESULTS We retrieved 81 articles, including 12 randomised controlled trial, 21 literature reviews, 13 descriptive studies, 6 experimental studies, 9 life-cycle studies, 6 cohort studies, 2 meta-analysis, 4 case reports and 8 other studies. It appears that pathogen transmission in the anaesthesia work area is mainly due to the lack of hand hygiene among the anaesthesia team. The benefit of single-use devices on infectious risk is based on weak scientific arguments, while reusable devices have benefits in terms of costs, water consumption, energy consumption, waste, and reducing greenhouse gas emissions. CONCLUSION Disposable medical devices and attire in the operating theatre do not mitigate the infectious risk to the patients but have a greater environmental, financial and social impact than the reusable ones. This study is the first step towards recommendations for more environmental-friendly practices in the operating theatre.
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Affiliation(s)
- Thibault Reynier
- Grenoble-Alpes University Hospital, Department of Anaesthesia and Intensive Care Medicine, F-38000 Grenoble, France
| | - Mathilde Berahou
- University of Rennes, CHU Rennes, Inserm, CIC 1414, COSS U1242, Anaesthesia and Intensive Care Medicine, F-35000 Rennes, France
| | - Pierre Albaladejo
- Grenoble-Alpes University Hospital, Department of Anaesthesia and Intensive Care Medicine, F-38000 Grenoble, France.
| | - Hélène Beloeil
- University of Rennes, CHU Rennes, Inserm, CIC 1414, COSS U1242, Anaesthesia and Intensive Care Medicine, F-35000 Rennes, France
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da Silva Fernandes C, Sousa Albuquerque Brandão MG, de Sousa Lima MM, do Nascimento JC, Galindo Neto NM, Moreira Barros L. Práticas seguras no manejo de vias aéreas de pacientes con Covid-19: revisión integradora. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introdução: A pandemia causada pelo vírus SARS-CoV-2 no início de 2020 alterou práticas dos profissionais de saúde com a finalidade em atenuar os riscos de contaminação dos trabalhadores da linha de frente de assistência à saúde, principalmente, atividades relacionadas ao manejo de vias aéreas de pacientes com Covid-19. Objetivo: identificar as práticas necessárias para garantir a segurança dos profissionais de saúde no manejo de vias aéreas de pacientes suspeitos ou diagnosticados com Covid-19. Materiais e métodos: revisão integrativa realizada em dez bases de dados relevantes na área da saúde, sendo a amostra composta por 17 pesquisas. As práticas identificadas foram elencadas conforme os quatro procedimentos pontuados pela literatura: intubação endotraqueal, extubação, broncoscopia e traqueostomia. Resultados: as principais recomendações mencionadas foram: intubação endotraqueal: realizada por equipe experiente, treinada, mínima e profissionais de grupos de risco para Covid-19 não devem fazer parte desta equipe; extubação: não utilizar cateter nasal de alto fluxo após o procedimento; broncoscopia: realizar em sala isolada e com pressão negativa; traqueostomia: poderá ser considerada precocemente, mas o risco-benefício deve ser avaliado. Conclusão: as práticas identificadas poderão direcionar o gerenciamento de vias aéreas e nortear a construção de tecnologias assistenciais, educacionais ou gerenciais.
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Murphy MT, Latif U. Pain During COVID-19: A Comprehensive Review and Guide for the Interventionalist. Pain Pract 2020; 21:132-143. [PMID: 33295042 DOI: 10.1111/papr.12976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/08/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic pain, the leading cause of disability in the world, imposes limitations on activities of daily living and diminishes quality of life leading to unnecessary patient suffering. The personal and socioeconomic costs of chronic pain cannot be overstated. Physicians are at the crux of the pandemic and must attempt to limit the spread of the virus while maintaining their professional responsibility to their patients and staff members. OBJECTIVE The aim of this review is to analyze the existing literature to develop consensus recommendations for treating pain during the current COVID-19 pandemic. METHODS Relevant literature was located via computer-generated citations between the months of March and May of 2020. Online computer searches of multiple databases including Google Scholar, CINAHL, PubMed, and Cochrane Review were conducted in conjunction with a thorough review of local, state, national, and international governmental and organizational websites to locate research on the area of interest. RESULTS The guidelines in this review are meant to offer a framework to pain practitioners and organizations for providing highly effective, ethical, and safe care to patients while maintaining their commitment to mitigating the spread of the COVID-19 pandemic. Specific areas addressed include general and interventional-specific treatment and mitigation recommendations. CONCLUSIONS We believe that the recommendations in this review, if used in conjunction with evolving recommendations of Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and federal, state, and local governing bodies, provides a path to not only mitigate the spread of the pandemic but also limit the adverse impact of pain and suffering in chronic pain patients.
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Affiliation(s)
- Micheal T Murphy
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Usman Latif
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
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Abejón D, Monzón EM, Deer T, Hagedorn JM, Araujo R, Abad C, Rios A, Zamora A, Vallejo R. How to Restart the Interventional Activity in the COVID-19 Era: The Experience of a Private Pain Unit in Spain. Pain Pract 2020; 20:820-828. [PMID: 32969188 PMCID: PMC7536921 DOI: 10.1111/papr.12951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/24/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The situation generated in the health system by the COVID-19 pandemic has provoked a crisis involving the necessity to cancel non-urgent and oncologic activity in the operating room and in day-to-day practice. As the situation continues, the need to reinstate attention for patients with chronic pain grows. The restoration of this activity has to begin with on-site appointments and possible surgical procedures. On-site clinical activity has to guarantee the safety of patients and health workers. OBJECTIVES The objective of this review was to evaluate how to manage activity in pain units, considering the scenario generated by the pandemic and the implications of chronic pain on the immune system and proposed pharmacological and interventional therapies. METHODS Besides the established general recommendations (physical distance, surgical masks, gloves, etc.), we established specific recommendations that will allow patient treatment and relieve the disruption of the immune response. It is important to highlight the use of opioids with the least influence in the immune system. Further, individualized corticoid use, risk assessment, reduced immune suppression, and dose adjustment should take patient needs into account. In this scenario, we highlight the use of radiofrequency and neuromodulation therapies, techniques that do not interfere with the immune response. CONCLUSIONS We describe procedures to implement these recommendations for individual clinical situations, the therapeutic possibilities and safety guidelines for each center, and government recommendations during the COVID-19 pandemic.
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Affiliation(s)
- David Abejón
- Pain Management Unit, Hospital Universitario Quirónsalud Madrid, Hospital Quirónsalud San José, Madrid, Spain
| | - Eva M Monzón
- Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - Tim Deer
- Spine and Nerve Center of the Virginias, Charleston, West Virginia, U.S.A
| | - Jonathan M Hagedorn
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Cristina Abad
- Pain Management Department, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - Alberto Rios
- Pain Management Department, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - Alejandro Zamora
- Pain Management Department, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - Ricardo Vallejo
- National Spine and Pain Centers, Rockville, MD, U.S.A.,Psychology Department, Illinois Wesleyan University, Bloomington, Illinois, U.S.A
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14
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Branch R, Amiri A. Environmental Surface Hygiene in the OR: Strategies for Reducing the Transmission of Health Care-Associated Infections. AORN J 2020; 112:327-342. [PMID: 32990964 DOI: 10.1002/aorn.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Health care-associated infections (HAIs) cost billions of dollars annually in the United States and cause patient morbidity and mortality. There is increasing evidence that environmental surfaces in the OR setting, including anesthesia work areas, can harbor pathogens that can lead to HAIs. Patient-care equipment used routinely in the OR, such as electrocardiograph wires, blood pressure cuffs, pulse oximetry probes, and monitor cables, can become contaminated with pathogens during surgical procedures; without proper cleaning and disinfection between procedures, these items pose a risk for pathogen transmission and subsequent patient infections. This article discusses the association between contaminated surfaces in the OR and the risk for HAIs. It is essential that perioperative nurses, environmental services personnel, anesthesia technicians, and anesthesia professionals properly disinfect environmental surfaces to prevent HAIs.
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15
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Dexter F, Elhakim M, Loftus RW, Seering MS, Epstein RH. Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic. J Clin Anesth 2020; 64:109854. [PMID: 32371331 PMCID: PMC7188624 DOI: 10.1016/j.jclinane.2020.109854] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 12/15/2022]
Abstract
We performed a narrative review to explore the economics of daily operating room management decisions for ambulatory surgery centers following resolution of the acute phase of the Coronavirus Disease 2019 (COVID-19) pandemic. It is anticipated that there will be a substantive fraction of patients who will be contagious, but asymptomatic at the time of surgery. Use multimodal perioperative infection control practices (e.g., including patient decontamination) and monitor performance (e.g., S. aureus transmission from patient to the environment). The consequence of COVID-19 is that such processes are more important than ever to follow because infection affects not only patients but the surgery center staff and surgeons. Dedicate most operating rooms to procedures that are not airway aerosol producing and can be performed without general anesthesia. Increase throughput by performing nerve blocks before patients enter the operating rooms. Bypass the phase I post-anesthesia care unit whenever possible by appropriate choices of anesthetic approach and drugs. Plan long-duration workdays (e.g., 12-h). For cases where the surgical procedure does not cause aerosol production, but general anesthesia will be used, have initial (phase I) post-anesthesia recovery in the operating room where the surgery was done. Use anesthetic practices that achieve fast initial recovery of the brief ambulatory cases. When the surgical procedure causes aerosol production (e.g., bronchoscopy), conduct phase I recovery in the operating room and use multimodal environmental decontamination after each case. Use statistical methods to plan for the resulting long turnover times. Whenever possible, have the anesthesia and nursing teams stagger cases in more than one room so that they are doing one surgical case while the other room is being cleaned. In conclusion, this review shows that while COVID-19 is prevalent, it will markedly affect daily ambulatory workflow for patients undergoing general anesthesia, with potentially substantial economic impact for some surgical specialties.
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Affiliation(s)
| | - Mohamed Elhakim
- Department of Anesthesia and Critical Care Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
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16
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Deer TR, Sayed D, Pope JE, Chakravarthy KV, Petersen E, Moeschler SM, Abd-Elsayed A, Amirdelfan K, Mekhail N. Emergence From the COVID-19 Pandemic and the Care of Chronic Pain: Guidance for the Interventionalist. Anesth Analg 2020; 131:387-394. [PMID: 32452905 PMCID: PMC7258839 DOI: 10.1213/ane.0000000000005000] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND: The current Coronavirus Disease (COVID-19) pandemic led to a significant disruption in the care of pain from chronic and subacute conditions. The impact of this cessation of pain treatment may have unintended consequences of increased pain, reduced function, increased reliance on opioid medications, and potential increased morbidity, due to the systemic impact of untreated disease burden. This may include decreased mobility, reduction in overall health status, and increase of opioid use with the associated risks. METHODS: The article is the study of the American Society of Pain and Neuroscience (ASPN) COVID-19 task force to evaluate the policies set forth by federal, state, and local agencies to reduce or eliminate elective procedures for those patients with pain from spine, nerve, and joint disease. The impact of these decisions, which were needed to reduce the spread of the pandemic, led to a delay in care for many patients. We hence review an emergence plan to reinitiate this pain-related care. The goal is to outline a path to work with federal, state, and local authorities to combat the spread of the pandemic and minimize the deleterious impact of pain and suffering on our chronic pain patients. RESULTS: The article sets forth a strategy for the interventional pain centers to reemerge from the current pandemic and to set a course for future events. CONCLUSIONS: xxx.
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Affiliation(s)
- Timothy R Deer
- From the Department of Pain Medicine, The Spine and Nerve Center of The Virginias, Charleston, West Virginia.,Department of Anesthesiology and Pain Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Jason E Pope
- Evolve Restorative Center, Santa Rosa, California
| | - Krishnan V Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, California.,Division of Pain Medicine, Department of Anesthesiology, Veterans Affairs (VA) San Diego Healthcare, San Diego, California
| | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Nagy Mekhail
- Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
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17
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Dexter F, Parra MC, Brown JR, Loftus RW. Perioperative COVID-19 Defense: An Evidence-Based Approach for Optimization of Infection Control and Operating Room Management. Anesth Analg 2020; 131:37-42. [PMID: 32217947 PMCID: PMC7172574 DOI: 10.1213/ane.0000000000004829] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We describe an evidence-based approach for optimization of infection control and operating room management during the Coronavirus Disease 2019 (COVID-19) pandemic. Confirmed modes of viral transmission are primarily, but not exclusively, contact with contaminated environmental surfaces and aerosolization. Evidence-based improvement strategies for attenuation of residual environmental contamination involve a combination of deep cleaning with surface disinfectants and ultraviolet light (UV-C). (1) Place alcohol-based hand rubs on the intravenous (IV) pole to the left of the provider. Double glove during induction. (2) Place a wire basket lined with a zip closure plastic bag on the IV pole to the right of the provider. Place all contaminated instruments in the bag (eg, laryngoscope blades and handles) and close. Designate and maintain clean and dirty areas. After induction of anesthesia, wipe down all equipment and surfaces with disinfection wipes that contain a quaternary ammonium compound and alcohol. Use a top-down cleaning sequence adequate to reduce bioburden. Treat operating rooms using UV-C. (3) Decolonize patients using preprocedural chlorhexidine wipes, 2 doses of nasal povidone-iodine within 1 hour of incision, and chlorhexidine mouth rinse. (4) Create a closed lumen IV system and use hub disinfection. (5) Provide data feedback by surveillance of Enterococcus, Staphylococcusaureus, Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter spp. (ESKAPE)transmission. (6) To reduce the use of surgical masks and to reduce potential COVID-19 exposure, use relatively long (eg, 12hours) staff shifts. If there are 8 essential cases to be done (each lasting 1–2 hours), the ideal solution is to have 2 teams complete the 8 cases, not 8 first case starts. (7) Do 1 case in each operating room daily, with terminal cleaning after each case including UV-C or equivalent. (8) Do not have patients go into a large, pooled phase I postanesthesia care unit because of the risk of contaminating facility at large along with many staff. Instead, have most patients recover in the room where they had surgery as is done routinely in Japan. These 8 programmatic recommendations stand on a substantial body of empirical evidence characterizing the epidemiology of perioperative transmission and infection development made possible by support from the Anesthesia Patient Safety Foundation (APSF).
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Affiliation(s)
- Franklin Dexter
- From the Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Michelle C Parra
- From the Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Jeremiah R Brown
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Randy W Loftus
- From the Department of Anesthesia, University of Iowa, Iowa City, Iowa
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18
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Dexter F, Epstein RH, Gostine AL, Penning DH, Loftus RW. Benefit of systematic selection of pairs of cases matched by surgical specialty for surveillance of bacterial transmission in operating rooms. Am J Infect Control 2020; 48:682-687. [PMID: 31679749 DOI: 10.1016/j.ajic.2019.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Bacterial transmission within and between successive surgical cases occurs in operating rooms (ORs), often includes anesthesia equipment as a reservoir, and can be monitored by collecting samples and identifying bacteria by genetic testing. We evaluated how to choose cases for active surveillance to quantify the effectiveness of interventions in 2 groups of ORs (eg, rooms with germicidal lighting vs those without). METHODS Data were from a 7 OR single-specialty gastrointestinal endoscopy suite and from a typical 8 OR multispecialty surgical suite. RESULTS At the multispecialty hospital, 40.3% (SE 1.2%) of the total number of cases could be used for surveillance (ie, followed by another case of the same specialty and matched with a corresponding pair of cases from the other OR group). Random selection obtained fewer matched pairs than deliberate selection: mean ratio of random/deliberate = 0.64 (0.01) for the single-specialty and 0.51 (0.02) for the multispecialty suite (P <.001). CONCLUSIONS The efficiency of sampling to obtain pairs of successive surgical cases of the same specialty is impaired markedly by randomly selecting pairs of cases (or using convenience sampling) as compared to choosing pairs deliberately. This is important because the number of cases that can be suitably used for surveillance of bacterial transmission will typically be less than one-half the total case number.
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19
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Lie SA, Wong SW, Wong LT, Wong TGL, Chong SY. Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic. Can J Anaesth 2020; 67:885-892. [PMID: 32212103 PMCID: PMC7095295 DOI: 10.1007/s12630-020-01637-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization on 11 March 2020 because of its rapid worldwide spread. In the operating room, as part of hospital outbreak response measures, anesthesiologists are required to have heightened precautions and tailor anesthetic practices to individual patients. In particular, by minimizing the many aerosol-generating procedures performed during general anesthesia, anesthesiologists can reduce exposure to patients’ respiratory secretions and the risk of perioperative viral transmission to healthcare workers and other patients. To avoid any airway manipulation, regional anesthesia should be considered whenever surgery is planned for a suspect or confirmed COVID-19 patient or any patient who poses an infection risk. Regional anesthesia has benefits of preservation of respiratory function, avoidance of aerosolization and hence viral transmission. This article explores the practical considerations and recommended measures for performing regional anesthesia in this group of patients, focusing on control measures geared towards ensuring patient and staff safety, equipment protection, and infection prevention. By doing so, we hope to address an issue that may have downstream implications in the way we practice infection control in anesthesia, with particular relevance to this new era of emerging infectious diseases and novel pathogens. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not the first, and certainly will not be the last novel virus that will lead to worldwide outbreaks. Having a well thought out regional anesthesia plan to manage these patients in this new normal will ensure the best possible outcome for both the patient and the perioperative management team.
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Affiliation(s)
- Sui An Lie
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Sook Wai Wong
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Loong Tat Wong
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Theodore Gar Ling Wong
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Shin Yuet Chong
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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20
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Birnbach DJ, Bateman BT. Obstetric Anesthesia: Leading the Way in Patient Safety. Obstet Gynecol Clin North Am 2019; 46:329-337. [PMID: 31056134 DOI: 10.1016/j.ogc.2019.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The subspecialty of obstetric anesthesiology has embraced patient safety research, which has led to a reduction in obstetric anesthesia-related morbidity and mortality. Although there are innumerable individual improvements, this article highlights the following innovations: safer and more effective labor analgesia, safer treatments for hypotension associated with neuraxial blockade, advances in spinal and epidural techniques for operative deliveries, lower incidence of postdural puncture headache through improved technology, safer parental agents for labor analgesia, improved safety of general anesthesia in obstetrics, improved education and the use of simulation including team training, and reductions in operating room-related infections.
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Affiliation(s)
- David J Birnbach
- University of Miami-Jackson Memorial Hospital Center for Patient Safety, University of Miami Miller School of Medicine, 1611 Northwest 12th Avenue, C-300, Miami, FL 33136, USA.
| | - Brian T Bateman
- Division of Obstetric Anesthesia, Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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21
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Birnbach DJ, McKenty NT, Rosen LF, Arheart KL, Everett-Thomas R, Lindsey SF. Does Adherence to World Health Organization Hand Hygiene Protocols in the Operating Room Have the Potential to Produce Irritant Contact Dermatitis in Anesthesia Providers? Anesth Analg 2019; 129:e182-e184. [PMID: 31743176 DOI: 10.1213/ane.0000000000004112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anesthesia providers have the burden of constant hand hygiene during task dense periods. The requirement for hand hygiene often demands frequent application of alcohol-based hand rub. To assess whether frequent alcohol-based hand rub use leads to skin changes or irritant contact dermatitis, volunteers cleaned their hands with alcohol-based hand rub every 15 minutes for 8 hours for 5 sequential days. They were examined by a dermatologist before and after and asked about subjective skin changes. Results suggest an increase in irritant contact dermatitis scores and subjective complaints.
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Affiliation(s)
- David J Birnbach
- From the Department of Anesthesiology, University of Miami Miller School of Medicine
- University of Miami-Jackson Memorial Hospital Center for Patient Safety, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Nathan T McKenty
- From the Department of Anesthesiology, University of Miami Miller School of Medicine
| | - Lisa F Rosen
- University of Miami-Jackson Memorial Hospital Center for Patient Safety, Miami, Florida
| | - Kristopher L Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | | | - Scott F Lindsey
- Department of Dermatology, University of Miami Miller School of Medicine
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22
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Segal S, Harris HM, Gunawan A, Schumann R. A Simple Method for Estimating Hand Hygiene Use Among Anesthesia Personnel: Development, Validation, and Use in a Quality Improvement Project. Anesth Analg 2019; 129:1549-1556. [PMID: 31743174 DOI: 10.1213/ane.0000000000004106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Frequent hand hygiene by anesthesia personnel may be an important factor in reducing contamination of IV lines and medication access ports and may reduce hospital-acquired infections. Measurement of hand hygiene frequency at the individual clinician level by direct observation or electronic devices is cumbersome and expensive. We developed and validated a simple method for estimating hand hygiene frequency by individual anesthesia providers and utilized it in a quality improvement initiative to increase hand hygiene use. METHODS Pump-style, alcohol-based hand hygiene container weight at the anesthesia work station was measured before and after each surgical operation and converted to estimated number of accesses (pumps) per hour. Video observation was used to validate the estimated hand hygiene use. A quality improvement initiative utilized periodic measurement of hand hygiene frequency via the validated method, and incorporated individual provider feedback, email reminders, monthly departmental performance reports, and reminders in the electronic anesthesia record. Segmented linear regression was used to evaluate the effect of the intervention on hand hygiene use. RESULTS Delivered product per pump was consistent for containers at least half-full and averaged (mean ± SD) 0.92 ± 0.13 g per pump. Video observation in 26 cases showed a strong correlation between observed hand hygiene episodes and estimated hand hygiene use frequency based on weight change of the container (linear regression, R = 0.97, P < .0001). Median hand hygiene frequency was near 0 at baseline but increased progressively throughout the intervention period (segmented linear regression, overall R = 0.76, P < .0001; change of intercept or mean hand hygiene after initiation of intervention [parameter estimate ± SE] [0.970 ± 0.29], P = .0008). CONCLUSIONS A low-cost, simple method for measuring individual anesthesia clinician use of hand hygiene intraoperatively based on container weight change is feasible and sufficiently accurate to support a quality improvement initiative to increase its use.
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Affiliation(s)
- Scott Segal
- From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Hannah M Harris
- From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Antonius Gunawan
- From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Roman Schumann
- Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts
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23
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Birnbach DJ, Thiesen TC, McKenty NT, Rosen LF, Arheart KL, Fitzpatrick M, Everett-Thomas R. Targeted Use of Alcohol-Based Hand Rub on Gloves During Task Dense Periods: One Step Closer to Pathogen Containment by Anesthesia Providers in the Operating Room. Anesth Analg 2019; 129:1557-1560. [PMID: 31743175 DOI: 10.1213/ane.0000000000004107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anesthesia providers' hand hygiene practices in the operating room may contribute to the transmission of bacteria. There is a debate, however, over the best approaches for pathogen containment during task dense periods (induction and extubation) of anesthesia care. A novel approach to reducing pathogen spread during these task dense periods is the use of alcohol-based hand rub on gloves when it may be difficult to either change gloves or clean hands. METHODS To evaluate the impact of alcohol-based hand rub on gloves, we estimated perforation rates of 50 gloves that were worn as pairs by volunteers for 2 hours at a time applying alcohol-based hand rub every 15 minutes (total of 8 alcohol-based hand rub applications per pair of gloves). We also identified perforation rates of 50 new, unused gloves. To evaluate the ability to perform routine anesthesia functions, volunteers were asked to pick up a coin from a table top and document whether the gloves felt normal or sticky at each 15-minute period. RESULTS Fifty new gloves (not exposed to alcohol-based hand rub) were tested for integrity using the Food and Drug Administration-approved process, and one was found to have a microperforation. Of the 50 gloves that had been applied with alcohol-based hand rub 8 times, no microperforations were identified. All volunteers demonstrated tactile competence by picking up a coin from a table top after 8 alcohol-based hand rub applications; in addition, as the number of alcohol-based hand rub applications progressed, the volunteers reported increased stickiness. CONCLUSIONS This study suggests that the use of alcohol-based hand rub on commonly used nitrile examination gloves does not compromise glove integrity or hamper the ability to safely perform routine anesthesia functions.
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Affiliation(s)
- David J Birnbach
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
- University of Miami-Jackson Memorial Hospital Center for Patient Safety, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Taylor C Thiesen
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Nathan T McKenty
- From the Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Lisa F Rosen
- University of Miami-Jackson Memorial Hospital Center for Patient Safety, Miami, Florida
| | - Kristopher L Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Maureen Fitzpatrick
- University of Miami-Jackson Memorial Hospital Center for Patient Safety, Miami, Florida
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24
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Kwanten LE. Anaesthetists and syringe hygiene: getting to the pointy end – a summary of recommendations. Br J Anaesth 2019; 123:e475-e479. [DOI: 10.1016/j.bja.2019.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/03/2019] [Accepted: 05/22/2019] [Indexed: 11/26/2022] Open
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25
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Simpao AF, Rehman MA. Dyeing to Find Out How an "AWEsim" Bundle Can Impact Anesthesia Work Environment Contamination. Anesth Analg 2019; 127:594-595. [PMID: 30113973 DOI: 10.1213/ane.0000000000003323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Allan F Simpao
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mohamed A Rehman
- Department of Anesthesiology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
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26
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Schuler F, Lanckohr C, Pillukat MH, Scherf R, Mellmann A. [Hygiene aspects of multidrug-resistant pathogens in the operating room and intensive care unit]. Anaesthesist 2019; 68:329-340. [PMID: 31049601 DOI: 10.1007/s00101-019-0594-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The major multidrug-resistant pathogens (MRE) in human medicine are methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and multidrug-resistant Gram-negative rod bacteria (MRGN). MRE are a very heterogeneous group with respect to epidemiology and therapeutic or hospital hygiene consequences. After MRSA played an important role among MREs at the beginning of the twenty-first century, VRE and MRGN have come to the fore in recent years. During work in the operating room and on the intensive care unit, there are many possibilities for transmission of MRE between the patient environment and the patient, especially via the hands, e. g. during intubation or catheterization in vessels, tissues or the urinary tract. For this reason, hand and surface hygiene is of particular relevance in the prevention of nosocomial colonization or infection, in particular with MRE.
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Affiliation(s)
- F Schuler
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Münster, Domagkstr. 10, 48149, Münster, Deutschland.
| | - C Lanckohr
- Institut für Hygiene, Universitätsklinikum Münster, Robert-Koch-Straße 41, 48149, Münster, Deutschland
| | - M Hendrik Pillukat
- Institut für Hygiene, Universitätsklinikum Münster, Robert-Koch-Straße 41, 48149, Münster, Deutschland
| | - R Scherf
- Institut für Hygiene, Universitätsklinikum Münster, Robert-Koch-Straße 41, 48149, Münster, Deutschland
| | - A Mellmann
- Institut für Hygiene, Universitätsklinikum Münster, Robert-Koch-Straße 41, 48149, Münster, Deutschland
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Plemmons MM, Marcenaro J, Oermann MH, Thompson J, Vacchiano CA. Improving infection control practices of nurse anesthetists in the anesthesia workspace. Am J Infect Control 2019; 47:551-557. [PMID: 30665777 DOI: 10.1016/j.ajic.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anesthesia providers commonly cross-contaminate their workspace and subsequently put patients at risk for a health care-acquired infection. The primary objective of this project was to determine if education and implementation of standardized infection control guidelines that address evidence-based best practices would improve compliance with infection control procedures in the anesthesia workspace. METHODS Patient care-related hand hygiene of nurse anesthetists was observed in 3 areas of anesthesia practice before and 3 weeks and 3 months after staff education, placement of visual reminders, and the implementation of infection control guidelines. After the observation periods, the percent compliance on the part of the providers was calculated for each of the 3 areas of anesthesia practice, and the results were compared using the Fisher exact test. RESULTS There were a total of 95 observations performed during the 3 observation periods. When compared with preimplementation baseline data, there was a 26.2% increase in the number of providers compliant with hand hygiene practices after airway instrumentation (P = .029) and a 71.9% increase in the number of providers who separated clean from contaminated items in the workspace (P = .0001). CONCLUSIONS Education, visual reminders, and standardized infection control guidelines were shown to improve compliance with infection control best practices in a group of nurse anesthetists.
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Affiliation(s)
| | | | | | | | - Charles A Vacchiano
- Duke University School of Nursing, Durham, NC; Duke University Hospital, Durham, NC
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Infection prevention in the operating room anesthesia work area. Infect Control Hosp Epidemiol 2018; 40:1-17. [DOI: 10.1017/ice.2018.303] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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A Simulation Study to Evaluate Improvements in Anesthesia Work Environment Contamination After Implementation of an Infection Prevention Bundle. Anesth Analg 2018; 127:662-670. [DOI: 10.1213/ane.0000000000002764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Assessing a Novel Method to Reduce Anesthesia Machine Contamination: A Prospective, Observational Trial. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2018; 2018:1905360. [PMID: 29623137 PMCID: PMC5829426 DOI: 10.1155/2018/1905360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/31/2017] [Indexed: 11/18/2022]
Abstract
Background Anesthesia machines are known reservoirs of bacterial species, potentially contributing to healthcare associated infections (HAIs). An inexpensive, disposable, nonpermeable, transparent anesthesia machine wrap (AMW) may reduce microbial contamination of the anesthesia machine. This study quantified the density and diversity of bacterial species found on anesthesia machines after terminal cleaning and between cases during actual anesthesia care to assess the impact of the AMW. We hypothesized reduced bioburden with the use of the AMW. Methods In a prospective, experimental research design, the AMW was used in 11 surgical cases (intervention group) and not used in 11 control surgical cases. Cases were consecutively assigned to general surgical operating rooms. Seven frequently touched and difficult to disinfect “hot spots” were cultured on each machine preceding and following each case. The density and diversity of cultured colony forming units (CFUs) between the covered and uncovered machines were compared using Wilcoxon signed-rank test and Student's t-tests. Results There was a statistically significant reduction in CFU density and diversity when the AMW was employed. Conclusion The protective effect of the AMW during regular anesthetic care provides a reliable and low-cost method to minimize the transmission of pathogens across patients and potentially reduces HAIs.
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Erichsen Andersson A, Frödin M, Dellenborg L, Wallin L, Hök J, Gillespie BM, Wikström E. Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study. BMC Health Serv Res 2018; 18:2. [PMID: 29301519 PMCID: PMC5753493 DOI: 10.1186/s12913-017-2783-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hand hygiene and aseptic techniques are essential preventives in combating hospital-acquired infections. However, implementation of these strategies in the operating room remains suboptimal. There is a paucity of intervention studies providing detailed information on effective methods for change. This study aimed to evaluate the process of implementing a theory-driven knowledge translation program for improved use of hand hygiene and aseptic techniques in the operating room. METHODS The study was set in an operating department of a university hospital. The intervention was underpinned by theories on organizational learning, culture and person centeredness. Qualitative process data were collected via participant observations and analyzed using a thematic approach. RESULTS Doubts that hand-hygiene practices are effective in preventing hospital acquired infections, strong boundaries and distrust between professional groups and a lack of psychological safety were identified as barriers towards change. Facilitated interprofessional dialogue and learning in "safe spaces" worked as mechanisms for motivation and engagement. Allowing for the free expression of different opinions, doubts and viewing resistance as a natural part of any change was effective in engaging all professional categories in co-creation of clinical relevant solutions to improve hand hygiene. CONCLUSION Enabling nurses and physicians to think and talk differently about hospital acquired infections and hand hygiene requires a shift from the concept of one-way directed compliance towards change and learning as the result of a participatory and meaning-making process. The present study is a part of the Safe Hands project, and is registered with ClinicalTrials.gov (ID: NCT02983136 ). Date of registration 2016/11/28, retrospectively registered.
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Affiliation(s)
- Annette Erichsen Andersson
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden. .,Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Maria Frödin
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisen Dellenborg
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden
| | - Lars Wallin
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden.,School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Solna, Sweden
| | - Jesper Hök
- GPCC Implement, University of Gothenburg, Gothenburg, Sweden
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Nathan, Australia.,Gold Coast University Hospital and Health Service, Southport, Australia
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Sweden
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The importance of infection control and prevention in anesthesiology. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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The importance of infection control and prevention in anesthesiology☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201712002-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Zorrilla-Vaca A, Escandón-Vargas K. La importancia del control y prevención de enfermedades infecciosas en anestesiología. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Martin LD, Kallile M, Kanmanthreddy S, Zerr DM. Infection prevention in pediatric anesthesia practice. Paediatr Anaesth 2017; 27:1077-1083. [PMID: 29030929 DOI: 10.1111/pan.13252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 12/12/2022]
Abstract
Healthcare-associated infections are an important source of morbidity and mortality in pediatric patients. Anesthesiologists have a unique role in infection prevention. Hand hygiene and anesthesia workspace decontamination decrease infection rates in surgical patients. Standard protocols exist for insertion and handling of central lines, arterial lines, and regional procedures, which should be strictly adhered to in order to prevent infectious complications. Temperature control and timely administration of antibiotics contribute to the prevention of surgical site infections. Education, culture shift, staff engagement, and effective change management are necessary for successful implementation of infection prevention strategies.
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Affiliation(s)
- Lizabeth D Martin
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Michael Kallile
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Siri Kanmanthreddy
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Danielle M Zerr
- Department of Pediatrics and Seattle Children's Research Institute, University of Washington, Seattle, WA, USA
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Nottingham M, Peterson G, Doern C, Doll M, Masroor N, Sanogo K, Stevens M, Bearman G. Ultraviolet-C light as a means of disinfecting anesthesia workstations. Am J Infect Control 2017; 45:1011-1013. [PMID: 28431851 DOI: 10.1016/j.ajic.2017.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/11/2017] [Accepted: 02/12/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anesthesia workstations (AWs) are a reservoir for pathogenic organisms potentially associated with surgical site infections. This study examined the effectiveness of the Tru-D SmartUVC device (Tru-D LLC, Nashville, TN) on bioburden reduction (BR) on AWs. METHODS Strips of tissue inoculated with a known concentration of either Staphylococcus aureus, Enterococcus faecalis, or Acinetobacter sp were placed on 22 high-touch surfaces of an AW. Half of the AW surfaces received direct ultraviolet (UV) light exposure and half received indirect exposure. Two inoculated strips, in sterile tubes outside of the room, represented the control. Trials were conducted on AWs in an operating room and a small room. Strips were placed in a saline solution, vortexed, and plated on blood agar to assess BR by the number of colony forming units. RESULTS All experimental trials, compared with controls, exhibited a BR >99%. There was a significantly greater reduction of E faecalis colony forming units in the operating room AW under direct exposure (P = .019) compared with indirect exposure. There was no significant difference in reduction when comparing AWs between rooms. CONCLUSION Regardless of room size and exposure type, automated UV-C treatment greatly influences BR on AW high-touch surfaces. Hospitals instituting an automated UV-C system as an infection prevention adjunct should consider utilizing it in operating rooms for BR as part of a horizontal infection prevention surgical site infection-reduction strategy.
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Affiliation(s)
- Matthew Nottingham
- Virginia Commonwealth University School of Medicine, Richmond, VA; Virginia Commonwealth University Health System, Richmond, VA.
| | - Gene Peterson
- Virginia Commonwealth University Health System, Richmond, VA
| | | | - Michelle Doll
- Virginia Commonwealth University Health System, Richmond, VA
| | - Nadia Masroor
- Virginia Commonwealth University Health System, Richmond, VA
| | - Kakotan Sanogo
- Virginia Commonwealth University Health System, Richmond, VA
| | - Michael Stevens
- Virginia Commonwealth University Health System, Richmond, VA
| | - Gonzalo Bearman
- Virginia Commonwealth University Health System, Richmond, VA
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Kampf G, Lemmen S. Disinfection of gloved hands for multiple activities with indicated glove use on the same patient. J Hosp Infect 2017. [PMID: 28648454 DOI: 10.1016/j.jhin.2017.06.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most hand hygiene guidelines recommend that gloves should be changed during patient care when an indication for hand disinfection occurs. Observational studies indicate that the majority of healthcare workers (HCWs) do not disinfect their hands at all during continued glove wear. The aim of this narrative review is to assess the potential benefits and risks for disinfecting gloved hands during patient care for multiple activities with indicated glove use on the same patient. Continued glove wear for multiple activities on the same patient often results in performing procedures, including aseptic procedures with contaminated gloves, especially in a setting where there are many indications in a short time, e.g. anaesthetics or accident and emergency departments. Of further note is that hand hygiene compliance is often lower when gloves are worn. To date, three independent studies have shown that decontamination is at least as effective on gloved hands as on bare hands and that puncture rates are usually not higher after up to 10 disinfections. One study on a neonatal intensive care unit showed that promotion of disinfecting gloved hands during care on the same patient resulted in a significant reduction in the incidence of late-onset infections and of necrotizing enterocolitis. We conclude that disinfection of gloved hands by HCWs may substantially reduce the risk of transmission when gloves are indicated for the entire episode of patient care and when performed during multiple activities on the same patient.
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Affiliation(s)
- G Kampf
- Knieler und Team GmbH, Infection Control Science, Hamburg, Germany; University Medicine Greifswald, Institute for Hygiene and Environmental Medicine, Greifswald, Germany.
| | - S Lemmen
- University Hospital Aachen, Department of Infection Control and Infectious Diseases, Aachen, Germany
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Wood A. Clinical Issues-April 2017. AORN J 2017; 105:413-419. [PMID: 28336031 DOI: 10.1016/j.aorn.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/08/2017] [Indexed: 11/21/2022]
Abstract
Patient involvement in hand hygiene Key words: patient engagement, hand hygiene, hand washing stations, hand hygiene promotion. Alcohol-based surgical hand rubs in the OR Key words: hand hygiene, hand rub, dispenser. Personal hand hygiene dispensers Key words: hand hygiene, hand rub, hand rub dispenser, personal dispenser. Hand soap Key words: soap, hand hygiene, hand wash, plain soap, triclosan. Disposal of water used for plaster application in scrub sinks Key words: plaster, pour, sink, scrub sink. Multiple hand hygiene indications Key words: hand hygiene, hand wash, hand rub.
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Jelacic S, Craddick K, Nair BG, Bounthavong M, Yeung K, Kusulos D, Knutson JA, Somani S, Bowdle A. Relative costs of anesthesiologist prepared, hospital pharmacy prepared and outsourced anesthesia drugs. J Clin Anesth 2017; 36:178-183. [DOI: 10.1016/j.jclinane.2016.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 09/15/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
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Dubler S, Zimmermann S, Fischer M, Schnitzler P, Bruckner T, Weigand MA, Frank U, Hofer S, Heininger A. Bacterial and viral contamination of breathing circuits after extended use - an aspect of patient safety? Acta Anaesthesiol Scand 2016; 60:1251-60. [PMID: 27470996 DOI: 10.1111/aas.12768] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND In the past, anaesthetic breathing circuits were identified as a source of pathogen transmission. It is still debated, whether breathing circuits combined with breathing system filters can be safely used for more than 1 day. The aim of this study was to evaluate the transmission risk of bacteria and also viruses via breathing circuits after extended use. METHODS The inner and outer surface of 102 breathing circuits used for 1 day and of 101 circuits used for 7 days were examined for bacteria and viruses. Additionally, 10 and 20 breathing circuits each were examined after use on patients with pulmonary virus infection and with multidrug-resistant organism (MDRO) colonisation/infection respectively. Bacteria were detected by standard microbiological procedures; PCR techniques were applied for herpes simplex virus, cytomegalovirus, influenza, parainfluenza and respiratory syncytial virus. RESULTS Endoluminal bacterial contamination of breathing circuits remained unchanged after 7-day vs. 1-day use (5.9% vs. 7.8%) [CI95%: -0.0886-0.0506, pnon-inferiority 0.0260]. Only outside surface contamination with bacteria belonging to environmental species or human flora increased (16.8 vs. 6.9%) [CI 95%: 0.0118 - 0.1876, pnon-inferiority 0.8660]. Viruses occurred on the patient side, but not in breathing circuits. No MDRO occurred in the 20 circuits after use on patients harbouring such germs. CONCLUSION Endoluminal contamination of breathing circuits with bacteria did not increase after extended use. No viruses were detected in the breathing circuits using filters. Based on our results, the extended use of ABC without exceptions appears safe, if a high level of anaesthesia workplace cleaning is secured.
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Affiliation(s)
- S. Dubler
- Department of Anaesthesiology; Heidelberg University Hospital; Heidelberg Germany
| | - S. Zimmermann
- Department of Infectious Diseases, Medical Microbiology and Hygiene; Division Bacteriology; Heidelberg University Hospital; Heidelberg Germany
| | - M. Fischer
- Department of Infectious Diseases, Virology; Heidelberg University Hospital; Heidelberg Germany
| | - P. Schnitzler
- Department of Infectious Diseases, Virology; Heidelberg University Hospital; Heidelberg Germany
| | - T. Bruckner
- Institute for Medical Biometry and Informatics; University of Heidelberg; Heidelberg Germany
| | - M. A. Weigand
- Department of Anaesthesiology; Heidelberg University Hospital; Heidelberg Germany
| | - U. Frank
- Department of Infectious Diseases, Medical Microbiology and Hygiene; Division Hospital and Environmental Hygiene; Heidelberg University Hospital; Heidelberg Germany
| | - S. Hofer
- Department of Anaesthesiology; Heidelberg University Hospital; Heidelberg Germany
| | - A. Heininger
- Department of Infectious Diseases, Medical Microbiology and Hygiene; Division Hospital and Environmental Hygiene; Heidelberg University Hospital; Heidelberg Germany
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Biddle C, Robinson K, Pike B, Kammerman M, Gay B, Verhulst B. Quantifying the rambunctious journey of the anesthesia provider's hands during simulated, routine care. Am J Infect Control 2016; 44:873-8. [PMID: 27040571 DOI: 10.1016/j.ajic.2016.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 11/26/2022]
Abstract
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.
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Goebel U, Gebele N, Ebner W, Dettenkofer M, Bürkle H, Hauschke D, Schulz-Stübner S. Bacterial Contamination of the Anesthesia Workplace and Efficiency of Routine Cleaning Procedures. Anesth Analg 2016; 122:1444-7. [DOI: 10.1213/ane.0000000000001220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Recurrent Visual Electronic Hand Hygiene Reminders in the Anesthesia Work Area. Infect Control Hosp Epidemiol 2016; 37:872-4. [PMID: 26861513 DOI: 10.1017/ice.2016.29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Birnbach DJ, Rosen LF, Fitzpatrick M, Carling P, Arheart KL, Munoz-Price LS. A New Approach to Pathogen Containment in the Operating Room: Sheathing the Laryngoscope After Intubation. Anesth Analg 2016. [PMID: 26214550 DOI: 10.1213/ane.0000000000000854] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anesthesiologists may contribute to postoperative infections by means of the transmission of blood and pathogens to the patient and the environment in the operating room (OR). Our primary aims were to determine whether contamination of the IV hub, the anesthesia work area, and the patient could be reduced after induction of anesthesia by removing the risk associated with contaminants on the laryngoscope handle and blade. Therefore, we conducted a study in a simulated OR where some of the participants sheathed the laryngoscope handle and blade in a glove immediately after it was used to perform an endotracheal intubation. METHODS Forty-five anesthesiology residents (postgraduate year 2-4) were enrolled in a study consisting of identical simulation sessions. On entry to the simulated OR, the residents were asked to perform an anesthetic, including induction and endotracheal intubation timed to approximately 6 minutes. Of the 45 simulation sessions, 15 were with a control group conducted with the intubating resident wearing single gloves, 15 with the intubating resident using double gloves with the outer pair removed and discarded after verified intubation, and 15 wearing double gloves and sheathing the laryngoscope in one of the outer gloves after intubation. Before the start of the scenario, the lips and inside of the mouth of the mannequin were coated with a fluorescent marking gel. After each of the 45 simulations, an observer examined the OR using an ultraviolet light to determine the presence of fluorescence on 25 sites: 7 on the patient and 18 in the anesthesia environment. RESULTS Of the 7 sites on the patient, ultraviolet light detected contamination on an average of 5.7 (95% confidence interval, 4.4-7.2) sites under the single-glove condition, 2.1 (1.5-3.1) sites with double gloves, and 0.4 (0.2-1.0) sites with double gloves with sheathing. All 3 conditions were significantly different from one another at P < 0.001. Of the 18 environmental sites, ultraviolet light detected fluorescence on an average of 13.2 (95% confidence interval, 11.3-15.6) sites under the single-glove condition, 3.5 (2.6-4.7) with double gloves, and 0.5 (0.2-1.0) with double gloves with sheathing. Again, all 3 conditions were significantly different from one another at P < 0.001. CONCLUSIONS The results of this study suggest that when an anesthesiologist in a simulated OR sheaths the laryngoscope immediately after endotracheal intubation, contamination of the IV hub, patient, and intraoperative environment is significantly reduced.
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Affiliation(s)
- David J Birnbach
- From the *Department of Anesthesiology, University of Miami - Jackson Memorial Hospital Center for Patient Safety, University of Miami Miller School of Medicine, Miami, Florida; †Department of Medicine Infectious Diseases, Boston Medical Center, Boston, Massachusetts; ‡Department of Public Health Science, University of Miami Miller School of Medicine, Miami, Florida; and §Institute for Health and Society, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Krombach JW, Marks JD, Dubowitz G, Radke OC. Development and Implementation of Checklists for Routine Anesthesia Care. Anesth Analg 2015; 121:1097-1103. [DOI: 10.1213/ane.0000000000000923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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