Hand hygiene and aseptic techniques during routine anesthetic care - observations in the operating room.

Veronika Megeus, Kerstin Nilsson, Jon Karlsson, Bengt I Eriksson, Annette Erichsen Andersson
Author Information
  1. Veronika Megeus: The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden.
  2. Kerstin Nilsson: The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden.
  3. Jon Karlsson: Department of Orthopedics, Sahlgrenska Academy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
  4. Bengt I Eriksson: Department of Orthopedics, Sahlgrenska Academy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
  5. Annette Erichsen Andersson: The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden.

Abstract

BACKGROUND: More knowledge is needed about task intensity in relation to hand hygiene in the operating room during anesthetic care in order to choose effective improvement strategies. The aim of this study was to explore the indications and occurrence of hand hygiene opportunities and the adherence to hand hygiene guidelines during routine anesthetic care in the operating room.
METHODS: Structured observational data on hand hygiene during anesthetic care during 94 surgical procedures was collected using the World Health Organization's observational tool in a surgical department consisting of 16 operating rooms serving different surgical specialties such as orthopedic, gynecological, urological and general surgery.
RESULTS: A total of 2,393 opportunities for hand hygiene was recorded. The number of hand hygiene opportunities when measured during full-length surgeries was mean���=���10.9/hour, SD 6.1 with an overall adherence of 8.1%. The corresponding numbers for the induction phase were, mean =77.5/h, SD 27.4 with an associated 3.1% adherence to hand hygiene guidelines. Lowest adherence was observed during the induction phase before an aseptic task (2.2%) and highest during full-length surgeries after body fluid exposure (15.9%).
CONCLUSIONS: There is compelling evidence for low adherence to hand hygiene guidelines in the operating room and thus an urgent need for effective improvement strategies. The conclusion of this study is that any such strategy should include education and practical training in terms of how to carry out hand hygiene and aseptic techniques and how to use gloves correctly. Moreover it appears to be essential to optimize the work processes in order to reduce the number of avoidable hand hygiene opportunities thereby enhancing the possibilities for adequate use of HH during anesthetic care.

References

  1. Clin Infect Dis. 2006 Jan 15;42 Suppl 2:S82-9 [PMID: 16355321]
  2. Am J Infect Control. 2013 Oct;41(10):922-4 [PMID: 24074540]
  3. Infect Control Hosp Epidemiol. 2012 Sep;33(9):897-904 [PMID: 22869263]
  4. Am J Infect Control. 2014 Feb;42(2):106-10 [PMID: 24355490]
  5. Anesth Analg. 2011 Jan;112(1):98-105 [PMID: 20686007]
  6. Implement Sci. 2013 Feb 04;8:16 [PMID: 23379466]
  7. J Hosp Infect. 2011 Apr;77(4):358-9 [PMID: 21316121]
  8. Anesthesiology. 1994 Aug;81(2):488-500 [PMID: 8053599]
  9. J Hosp Infect. 2001 Aug;48 Suppl A:S40-6 [PMID: 11759025]
  10. Infect Control Hosp Epidemiol. 2006 May;27(5):484-92 [PMID: 16671030]
  11. J Hosp Infect. 2004 Jun;57(2):162-9 [PMID: 15183248]
  12. Infect Control Hosp Epidemiol. 2014 Aug;35(8):1056-9 [PMID: 25026624]
  13. Am J Infect Control. 2009 Dec;37(10):827-34 [PMID: 20004812]
  14. AORN J. 1998 Oct;68(4):649-60 [PMID: 9795720]
  15. Antimicrob Resist Infect Control. 2013 Nov 18;2:31 [PMID: 24237856]
  16. Patient Saf Surg. 2012 Jun 14;6(1):11 [PMID: 22697808]
  17. J Hosp Infect. 2007 Sep;67(1):9-21 [PMID: 17719685]
  18. Lancet Infect Dis. 2006 Oct;6(10):641-52 [PMID: 17008173]
  19. Am J Infect Control. 2011 Feb;39(1):19-26 [PMID: 21281883]
  20. Am J Infect Control. 2014 Jun;42(6):602-7 [PMID: 24837110]
  21. N Engl J Med. 1995 Jul 20;333(3):147-54 [PMID: 7791816]
  22. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005186 [PMID: 17443575]
  23. Anesthesiology. 2008 Sep;109(3):399-407 [PMID: 18719437]
  24. Int J Nurs Stud. 2013 Apr;50(4):464-74 [PMID: 22939048]
  25. PLoS One. 2011;6(8):e23001 [PMID: 21857979]
  26. Br J Anaesth. 2011 Oct;107(4):553-8 [PMID: 21665900]
  27. Anesth Analg. 2012 Jun;114(6):1236-48 [PMID: 22467892]
  28. JAMA. 2013 Nov 27;310(20):2191-4 [PMID: 24141714]
  29. JAMA. 2010 Sep 8;304(10):1116-7 [PMID: 20823438]
  30. Am J Infect Control. 2013 May;41(5 Suppl):S42-5 [PMID: 23622747]
  31. Int J Nurs Stud. 2013 Apr;50(4):518-26 [PMID: 23245456]
  32. Am J Infect Control. 2012 May;40(4):387-8 [PMID: 21864940]
  33. Am J Infect Control. 2014 Jul;42(7):698-701 [PMID: 24969122]
  34. Infect Control Hosp Epidemiol. 2009 Jul;30(7):611-22 [PMID: 19508124]
  35. J Hosp Infect. 2007 May;66(1):6-14 [PMID: 17276546]
  36. BMC Infect Dis. 2014 Jan 09;14:13 [PMID: 24405683]
  37. Anesth Analg. 2015 Apr;120(4):848-52 [PMID: 24836472]
  38. Am J Infect Control. 2012 Oct;40(8):750-5 [PMID: 22285652]
  39. Lancet. 2000 Oct 14;356(9238):1307-12 [PMID: 11073019]
  40. Infect Control Hosp Epidemiol. 2010 Mar;31(3):283-94 [PMID: 20088678]
  41. Lancet. 2003 Oct 11;362(9391):1225-30 [PMID: 14568747]
  42. Hum Factors. 1995 Mar;37(1):20-31 [PMID: 7790008]
  43. Am J Infect Control. 2013 Nov;41(11):1001-6 [PMID: 23669298]
  44. Infect Control Hosp Epidemiol. 2014 Jun;35(6):717-20 [PMID: 24799649]
  45. Am J Infect Control. 2010 May;38(4):332-4 [PMID: 20189686]
  46. Infect Control Hosp Epidemiol. 2011 Dec;32(12):1194-9 [PMID: 22080658]
  47. Anesthesiology. 1999 Dec;91(6):1882-90 [PMID: 10598633]
  48. Anesthesiology. 2014 Apr;120(4):801-6 [PMID: 24481419]
  49. Am J Infect Control. 2010 Nov;38(9):711-7 [PMID: 21034980]
  50. Microbes Infect. 2004 Sep;6(11):1033-42 [PMID: 15345236]
  51. Anesthesiology. 2009 May;110(5):978-85 [PMID: 19352154]
  52. Am J Infect Control. 2010 Jun;38(5 Suppl 1):S25-33 [PMID: 20569853]
  53. J Hosp Infect. 2014 Feb;86(2):110-6 [PMID: 24412643]
  54. Ann Intern Med. 1999 Jan 19;130(2):126-30 [PMID: 10068358]
  55. Lancet. 1948 Oct 23;2(6530):641-4 [PMID: 18890505]
  56. Am J Infect Control. 2012 Oct;40(8):756-9 [PMID: 22325482]

Word Cloud

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