Video observation to map hand contact and bacterial transmission in operating rooms

• Published in: American journal of infection control Vol. 42; no. 7; pp. 698 - 701
• Main Authors: Rowlands, John, MD, Yeager, Mark P., MD, Beach, Michael, MD, PhD, Patel, Hetal M., BS, Huysman, Bridget C., BA, Loftus, Randy W., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-07-2014; Elsevier; Mosby-Year Book, Inc
• Subjects: Anesthesia - methods; Bacteria - isolation & purification; Biological and medical sciences; Compliance; Disease prevention; Disease transmission; Epidemiology. Vaccinations; Equipment and Supplies - microbiology; Equipment contamination; General aspects; Hand hygiene; Hand Hygiene - methods; Hands; Health care-associated infection; Human infectious diseases. Experimental studies and models; Humans; Hygiene; Infection Control; Infection Control - methods; Infectious Disease; Infectious diseases; Intervention; Medical sciences; Nosocomial infections; Operating Rooms; Hand hygiene; Health care-associated infection; Equipment contamination; Cartography; Nosocomial infection; Transmission; Check; Hand; Contamination; Infection; Prevention; Operating room; Bacteriosis; Hygiene
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2014.02.021

Background Hand hygiene (HH) is considered a primary intervention to avoid transmission of bacteria in health care settings and to prevent health care-associated infections. Despite efforts to decrease the incidence of health care-associated infections by improving HH, HH compliance rates vary widely depending on the hospital environment. Methods We used intraoperative video observation to map temporal patterns of anesthesia provider hand contact with anesthesia work environment (AWE) surfaces and to assess HH compliance. Serial bacterial cultures of high contact objects were subsequently used to characterize bacterial transmission over time. Results Using World Health Organization criteria, we found a large number of HH opportunities and a low rate of HH compliance by anesthesia providers (mean, 2.9%). We observed an inverse correlation between provider hand hygiene compliance during induction and emergence from anesthesia (3.2% and 4.1%, respectively) and the magnitude of AWE surface contamination (103 and 147 CFU, respectively) at these time points. We found no correlation between frequency of hand contact with the AWE and bacterial contamination. Conclusions Compliance with current HH recommendations by anesthesia providers is not feasible. However, there does appear to be a correlation between HH compliance rates and bacterial contamination of the AWE, an observation that should stimulate further work to design new methods for control of bacterial transmission in operating rooms.