Infection Control & Hospital Epidemiology (2019), 40,1–17 doi:10.1017/ice.2018.303
SHEA Expert Guidance
Infection prevention in the operating room anesthesia work area L. Silvia Munoz-Price MD, PhD1,, Andrew Bowdle MD, PhD2, B. Lynn Johnston MD3, Gonzalo Bearman MD, MPH4, Bernard C. Camins MD, MSc5, E. Patchen Dellinger MD2, Marjorie A. Geisz-Everson PhD, CRNA6, Galit Holzmann-Pazgal MD7, Rekha Murthy MD8, David Pegues MD9, Richard C. Prielipp MD, MBA, FCCM10, Zachary A. Rubin MD11, Joshua Schaffzin MD, PhD12, Deborah Yokoe MD, MPH13 and David J. Birnbach MD,
MPH14 1Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin, 2University of Washington, Seattle, Washington, 3Dalhousie University, Halifax, Nova Scotia, 4Virginia Commonwealth University School of Medicine, Richmond, Virginia, 5University of Alabama at Birmingham, Birmingham, Alabama, 6University of Southern Mississippi, Hattiesburg, Mississippi, 7Baylor College of Medicine, Houston, Texas, 8Cedars-Sinai Medical Center, Los Angeles, California, 9University of Pennsylvania, Philadelphia, Pennsylvania, 10University of Minnesota, Minneapolis, Minnesota, 11David Geffen School of Medicine at UCLA, Los Angeles, California, 12Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, 13University of California San Francisco School of Medicine, San Francisco, California and 14University of Miami Miller School of Medicine, Miami, Florida
(Received 15 October 2018; accepted 19 October 2018) Purpose
The potential for clinically significant microbial cross transmis- sion in the intraoperative environment poses a threat to patient safety. A growing body of literature has shown contamination in the anesthesia work area, including the anesthesia medical work cart, stopcocks, laryngeal masks and laryngoscope blades, touchscreens, and keyboards, as well as on providers’ hands, resulting in transmissions, healthcare-associated infections, and increased risk of patient mortality. The authors acknowledge that the operating room (OR) is a challenging environment in which to affect ideal infection pre- vention and control practices. In addition, infection prevention and control policies specific to anesthesia care in the OR are not universal; audits of infection prevention practices are not routine; and consequently, providers may not have clarity on expected practices and behaviors. Studies have reported problematic practices by anesthesia providers, including use of multiple-dose vials for >1 patient, <100% use of gloves for airway management, failure to perform hand hygiene (HH) after removing gloves, and entry into anesthesia cart drawers without performance of HH. This guidance provides recommendations specific to the anes- thesia work area to improve infection prevention through HH, environmental disinfection, and implementation of effective improvement efforts. Furthermore, SHEA acknowledges significant challenges to implementing the array of infection prevention and control recommendations to affect OR culture in general, and the work flow of anesthesia providers in particular. Facility administrators will need to actively collaborate with anesthesia department lea- ders to build an implementation plan that is timely,
Author for correspondence: L. Silvia Muñoz-Price, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226. E-mail:
smunozprice@mcw.edu Cite this article: Munoz-Price LS, et al. (2019). Infection prevention in the operating room anesthesia work area. Infection Control & Hospital Epidemiology 2019, 40, 1–17. doi: 10.1017/ice.2018.303
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
comprehensive, and multidisciplinary, and that will allocate hospital resources to educate healthcare personnel and to acquire new infection prevention and control components (eg, single-use laryngoscopes). Facilities should consider this guidance document in revisions of their anesthesia OR policies. This guidance builds on the foundational premise that all
facilities where anesthesia services are delivered have formal infection prevention and control programs. Essential elements of these programs include, but are not limited to, policies and procedures for HH, safe preparation and delivery of intravenous medications, and environmental cleaning and disinfection. All individuals involved in these procedures require training appro- priate to their tasks, as well as regular skills assessments.
Authors
The writing panel (the authors) consists of current and past members of the SHEA Guidelines Committee and representatives of organizations that partnered with SHEA to write this docu- ment: Dr. David J. Birnbach, American Society of Anesthesiolo- gists (ASA); Dr. Richard C. Prielipp, Anesthesia Patient Safety Foundation (APSF); and Dr. Marjorie Geisz-Everson, American Association of Nurse Anesthetists (AANA). All panel members served as volunteers.
Intended Use
SHEA develops expert guidance documents (EGs) for topics of relatively narrow scope that lack the level of evidence required for a formal guideline developed using the GRADE or a similar systematic methodology but are important in provision of safe, effective healthcare. As such, systematic grading of the evidence level is not provided for individual recommendations. Each EG is based on a synthesis of limited evidence, theoretical rationale,
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