Transcript File - APIC Coastline Webpage

Easing the Pain:
Infection Control and Anesthesia
Susan A. Dolan, RN, MS, CIC
Children’s Hospital Colorado
Robin Stackhouse, MD
University of California, San Francisco
APIC Annual Education Conference June 7-9 2014
Anaheim, CA
Objective
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Identify 3 areas where there is a gap
between Anesthesia’s daily practice and
infection prevention & control
Utilize evidence based information to
address gaps in Anesthesia IP&C
Initiate the use of an IP&C assessment
tool with Anesthesia team at your facility
Anesthesia OR Work Environment
South Bay
Hand Hygiene-Expectations
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Prior to first interacting with patient
Prior to donning sterile gloves
After any invasive procedure
After manipulation of the airway
(intubation, suctioning)
After touching the patient for surgical
positioning
After glove removal
After retrieving a soiled or dropped item
from OR floor
Biddle C. Shah J. AJIC 2012:40(8):756-9
Results:
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8,000 HH opportunities were observed
Aggregate failure rate was 82% with a
range of 64% to 93% by provider group
Conclusions:
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HH was very poor among anesthesia
providers.
This intrinsic HH failure rate creates a
great opportunity for horizontal and
vertical vectors for nosocomial infection
Biddle C. Shah J. AJIC 2012:40(8):756-9
Anesthesia
Contact of Surfaces by
Anesthesiologist
Induction
154.8
60
Maintenance
0
20
40
60
Per hour
Munoz-Prize, Infect Control
Hosp Epidemiology 2014
80
100
120
140
160
Hand hygiene by
Anesthesiologist
Anesthesia
1.8
Induction
154.8
Handhygiene
Contact
1.19
Maintenance
60
0
20
40
60
80
100
Per hour
Munoz-Prize, Infect Control
Hosp Epidemiology 2014
120
140
160
Major categories of HH failure
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Moving between patients during pre-op
Before, during and after placing nerve blocks
After any invasive procedure
Soiled gloves left on after airway
manipulation
After touching the patient for surgical
positioning
After picking up item from floor (pen, tape)
and using it.
Biddle C. Shah J. AJIC 2012:40(8):756-9
Work flow issues:
Intubation….. Adjusting gases and vent
settings
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Double glove?
Remove outer gloves and not perform HH
Wear gloves for identified “dirty
environment”?
Where to go from here?
Collaborative Approach
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The Inside View:
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Anesthesiology team
Surgical team
The Outside View:
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Infection Prevention team
Share Anesthesia IP&C Assessment Tool
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P&P
Hand Hygiene / Glove use
PPE / Attire
Environment (clean vs. dirty)
OR Attire
Safe injection practices and medications
IV supplies and therapy
Respiratory care procedures / equipment
Disinfection
Exposure Management
Recommendations / Suggestions
1. Clearly define “clean” and “dirty” areas during a case:
“Clean”: medication prep area / IV access / (intubation)
“Dirty”: keyboards / anesthesia machine / trash containers/
floor.
2. Perform hand hygiene when changing from “dirty” to
“clean”.
2. Have alcohol gel dispensers accessible
3. Perform HH as you enter and exit the OR
4. Perform HH prior to donning sterile gloves
6. Before accessing clean supplies, med prep or administration
7. Double glove during intubation?
remove the outer set immediately after intubation (1 study found
contamination of intraoperative environment was dramatically reduced).
see abstract online in Anesthesia & Analgesia May 15
Thank you!