Most hospital patients at risk for bacterial infection undergo an anesthetic: implications for infection control practices related to the anesthesia workspace

• Published in: Canadian journal of anesthesia Vol. 70; no. 8; pp. 1330 - 1339
• Main Authors: Epstein, Richard H., Dexter, Franklin, Loftus, Randy W.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-08-2023; Springer Nature B.V
• Subjects: Anesthesia; Anesthesia - adverse effects; Anesthesiology; Anesthetics; Anti-Bacterial Agents; Antibiotics; Bacterial infections; Bacterial Infections - chemically induced; Bacterial Infections - drug therapy; Bacterial Infections - prevention & control; Cardiology; Critical Care Medicine; Cross Infection - prevention & control; Delivery of Health Care; Disease control; Hospitals; Humans; Infection Control - methods; Intensive; Medicine; Medicine & Public Health; Methicillin-Resistant Staphylococcus aureus; Pain Medicine; Patients; Pediatrics; Pneumology/Respiratory System; Reports of Original Investigations; Retrospective Studies; Surgical site infections; Surgical Wound Infection - prevention & control; managerial epidemiology; nonoperating room anesthesia; antibiotic stewardship; health care-associated infections
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-023-02515-1

Purpose
Even with nearly 100% compliance with prophylactic antibiotic protocols, many surgical patients (> 5%) develop surgical site infections, some caused by pathogens transmitted from the anesthesia workspace (e.g., anesthesia machine), including multidrug-resistant
Staphylococcus aureus
. Reducing contamination of the anesthesia workspace substantively reduces the risk of surgical site infections. We estimated the percentage of hospital patients at risk for health care-associated infections who may benefit from the application of basic preventive measures under the control of anesthesia practitioners (e.g., their hand hygiene).
Methods
We conducted a retrospective cohort study which included every patient admitted to the University of Miami Health System from April 2021 through March 2022 for hospitalization, surgery, emergency department visits, or outpatient visits. Lists were created for the start date and times of every parenteral antibiotic administered and every anesthetic.
Results
Among 28,213 patient encounters including parenteral antibiotic(s), more than half (64.3%) also included an anesthetic (99% confidence interval, 62.2 to 66.6). The hypothesis that most antibiotics were administered during encounters when a patient underwent an anesthetic was accepted (
P
< 0.001). This observation may seem counterintuitive because parenteral antibiotics were administered for fewer than half of the 53,235 anesthetics (34.2%). The result was a consequence of most anesthetics (63.5%) at the health system being conducted in nonoperating room locations, and only 7.2% of such patients received a parenteral antibiotic.
Conclusions
Because approximately two-thirds of patients who receive an intravenous antibiotic also undergo an anesthetic, greater use of effective infection control measures in the anesthesia operating room workspace has the potential to substantively reduce overall rates of hospital infections.