Estimation of the contribution to intraoperative pathogen transmission from bacterial contamination of patient nose, patient groin and axilla, anesthesia practitioners' hands, anesthesia machine, and intravenous lumen

• Published in: Journal of clinical anesthesia Vol. 92; p. 111303
• Main Authors: Dexter, Franklin, Loftus, Randy W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2024; Elsevier Limited
• Subjects: Anesthesia; Anti-Bacterial Agents - therapeutic use; Axilla - microbiology; Bioinformatics; Catheters; Cross Infection - prevention & control; Disease control; Disease transmission; Disease Transmission, Infectious; Disinfection & disinfectants; Effectiveness studies; Equipment Contamination - prevention & control; Female; Groin - microbiology; Hands; Humans; Hygiene; Hypotheses; Iodine; Medical personnel; Nose; Pathogens; Patients; Retrospective Studies; Staphylococcus aureus; Staphylococcus infections; Surgical site infections
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2023.111303

Earlier studies showed net cost saving from anesthesia practitioners' use of a bundle of infection prevention products, with feedback on monitored Staphylococcus aureus intraoperative transmission. ESKAPE pathogens also include Enterococcus and gram-negative pathogens: Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter. We evaluated whether bacterial contamination of patient nose, patient groin and axilla, anesthesia practitioners' hands, anesthesia machine, and intravenous lumen all contribute meaningfully to ESKAPE pathogen transmission within anesthesia work areas.
The retrospective cohort study used bacterial count data from nine hospitals, 43 months, and 448 ESKAPE pathogen transmission events within anesthesia areas of 86 operating rooms. Transmission was measured within and between pairs of successive surgical cases performed in the same operating room on the same day.
There were 203 transmission events with S. aureus, 72 with Enterococcus, and 173 with gram negatives. ESKAPE pathogens in the nose contributed to transmission for 50% (99% confidence limit ≥45%) of case pairs, on the groin or axilla for 54% (≥49%), on the hands for 53% (≥47%), on the anesthesia machine for 21% (≥17%), and in the intravenous lumen for 24% (≥20%). ESKAPE pathogens in the nose started a transmission pathway for 27% (≥22%) of case pairs, on the groin or axilla for 24% (≥19%), on the hands for 38% (≥33%), on the anesthesia machine for 11% (≥7.6%), and in the intravenous lumen for 8.0% (≥5.3%). All P ≤ 0.0022 compared with 5%.
To prevent intraoperative ESKAPE pathogen transmission, anesthesia practitioners would need to address all five categories of infection control approaches: nasal antisepsis (e.g., povidone-iodine applied the morning of surgery), skin antisepsis (e.g., chlorhexidine wipes), hand antisepsis with dispensers next to the patient, decontamination of the anesthesia machine before and during anesthetics, and disinfecting caps for needleless connectors, disinfecting port protectors, and disinfecting caps for open female Luer type connectors.
•Prevention of intraoperative bacterial pathogen transmission needs all five bundle items?•Retrospective cohort study of ESKAPE pathogen transmission within anesthesia work areas.•>5% transmission pathways included patient, practitioner hands, and environment.•>5% transmission pathway starts for patient, practitioner hands, and environment.•Anesthesia practitioners need to use all five categories of infection control approaches.