Transcript quantify the dispersion of surrogate pathogen from

Quantifying the rambunctious journey of the anesthesia
provider’s hands during simulated, routine care
CJ Biddle CRNA, PhD, Kathryn Robinson, BSN, Benjamin Pike, BSN
Michael Kammerman, AS, Beverly Gay, RN, MSN, Brad Verhulst, PhD
Virginia Commonwealth University Medical Center, Richmond, VA
Study aims:
1) quantify the dispersion of surrogate pathogen from the mouth throughout the anesthesia workstation
during routine general anesthetic induction
2) test the hypothesis that there would be fewer contamination sites caused by providers who used a doublegloving technique
3) examine the effectiveness of the between-case anesthesia apparatus disinfection protocol
Routine interventions performed by all providers
Preoxygenation
Administering IV midazolam, fentanyl, lidocaine, propofol, succinylcholine
Adjusting the flow control of the intravenous fluids
Controlling ventilation by mask with an oral airway in situ
Performing laryngoscopy and placing an endotracheal tube
Connecting the circle system to breathing tube and inflating pilot balloon
Auscultating breath sounds
Securing the endotracheal tube with tape
Adjusting the mechanical ventilator settings to achieve normocarbia
Administering a volatile anesthetic agent via the anesthetic vaporizer
Readjusting the flow control of the intravenous fluids
Placing an orogastric tube and an esophageal temperature probe
Administering an intravenous antibiotic
Administering an intravenous antiemetic
The clear, odorless dye that we used (DAZO)
UV Light Source
(Wood’s Lamp)
The high fidelity Human Simulator where the DAZO was applied to the tip of the tongue)
Subjects were randomized to:
Group 1 (single pair)
Group 2 (double gloving)
+
Dye fluoresces under UV light. Example contamination sites (clockwise):
drug syringe, ventilator controls, vaporizer control, breathing circuit, IV flow control
Dye fluoresces under UV light. Example contamination sites (clockwise):
reservoir circuit breathing bag, drug injection ports, drawers on supply cart
Demonstration of group divergence when airway management
(successful intubation) is completed. When outer gloves are
removed (double gloving group) subsequent site contamination
decreases
20
Pairs of Gloves
Single
Double
10
5
Phase
Phase
Phase
Phase
Phase
0
Cumulative Average Number
of Surfaces Contaminated
15
Hashed Areas denote
95% Confidence Intervals
1a 1c 2a 2c 2e 2g 2i 2k 3b 3d 3f 3h 4a 4c 4e 4g 4i
1b 1d 2b 2d 2f 2h 2j 3a 3c 3e 3g 3i 4b 4d 4f 4h 4j
Progression of the Protocol
1
2
3
4
The effectiveness of cleaning the equipment
and anesthesia workstation was also evaluated
using the DAZO dye technique
TAKE-AWAY OUTCOMES OF STUDY:
• DOUBLE GLOVING ASSOCIATED LESS SPREAD OF SURROGATE PATHOGEN
• DOUBLE GLOVING WAS NOT UNIVERSALLY PROTECTIVE
• IV STOPCOCK CONTAMINATED IN 1/3 OF THE CASES OVERALL
• LITTLE DIFFERENCE IN STOPCOCK CONTAMINATION BY GLOVE GROUP
• ROUTINE BETWEEN CASE CLEANING VERY INEFFECTIVE
• ONLY STUDIED FIRST ~ 10 MINUTES OF A CASE
• EDUCATION, TRAINING AND EQUIPMENT REDESIGN DISCUSSED
• THE VALUE OF SIMULATION IN ADVANCING OUR UNDERSTANDING WAS
DEMONSTRATED