Infection Control Today

APR 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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20 ICT April 2019 www.infectioncontroltoday.com By Kelly M. Pyrek It is acknowledged that the operating room (OR) is a demanding environment in which to practice optimal infection prevention and control techniques, and new guidance points to the inconsistency with which practitioners observe policies. "There are several challenges for anesthesia providers that complicate compliance with infection prevention and control practices," confrms Andrew Bowdle MD, PhD, FASE, professor of anesthesiology and pharmaceutics in the Department of Anesthesiology at the University of Washington in Seattle. "Anesthesia providers work in a fast-paced environment where there is usually great emphasis placed on effciency, leaving little extra time for paying attention to infection control. The anesthesia workplace was never designed and constructed with infection control in mind, because our awareness of the impact of anesthesia infection control on hospital-acquired infection is relatively recent. Anesthesia providers have frequent, repeated contact with patients during an anesthetic. Studies have found that in many instances, following the WHO guidelines for hand hygiene would be virtually impossible in the anesthesia setting because providers would be constantly gelling and would have no time for anything else. The anesthesia workplace and anesthesia workfow has to be redesigned and adapted for infection control purposes." Bowdle is second author of the new expert guidance produced by the Society for Healthcare Epidemiology of America (SHEA) which is designed to provide instruction on how hospitals and healthcare providers may reduce infections associated with anesthesiology procedures and equipment in the OR. "The purpose of the SHEA expert guidance was to stimulate providers to think about these problems and to start the journey toward solving these problems," Bowdle adds. The guidance, published in SHEA's journal, Infection Control & Healthcare Epidemiology, recommends steps to improve infection prevention through increased hand hygiene, environmental disinfection, and continuous improvement plans, especially in the event of a lack of uniform institutional policy and procedures. The guidance was endorsed by the SHEA Board of Trustees, the American Academy of Anesthesiologist Assistants (AAAA), AANA, the Association of periOperative Registered Nurses (AORN), and APSF, with a letter of support from ASA. New Guidance Outlines Recommendations for Infection Control in Anesthesiology As the guidance observes, "…infection prevention and control policies specifc 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." "Even though the demands on anesthesia providers make infection prevention best practices more challenging, there are opportunities for improvement," says Silvia Munoz-Price, MD, PhD, lead author of the guidance and professor of medicine at Froedtert & Medical College of Wisconsin. "We describe how the anesthesiology team and hospital leaders can optimize infection prevention in operating room anesthesia, and we give suggestions for the future, including the need for better equipment design." A survey conducted by the SHEA Research Network (SRN) in 2016 documented that infection control policies and practices are inconsistent. Less than 36 percent of SRN respondents reported having infection prevention and control policies specifc to anesthesia practice in the OR, with international respondents more likely than U.S. respondents to have such policies. For respondents answering that there were no policies specifc to anesthesia, more than 97 percent reported the expectation that anesthesia provider practice in the OR would comply with institutional policies. Generally, facilities audited anesthesia providers' infection prevention and control practices in the OR when there was a concern about practices (52.5 percent), although 22 percent of respondents reported a monthly audit. Only 6.8 percent of respondents never conducted audits. In a 2017 SRN survey sent to members of ASA, AANA and AAAA, it was found that two-thirds of respondents reported having infection prevention and control guidelines specifc for anesthesia services in their institution. Alcohol-based hand rub (ABHR) was generally readily available within the anesthesia work area (always or usually: 93.8%) and was located at entry points to every OR (always or usually, 92.3%). Respondents identifed the following barriers to HH: lack of time in emergency situations (58.3%), lack of time in general (44.2%), skin factors (35.8%), HH equipment not easily accessible (27%), and lack of support from OR personnel for HH-related workfow interruptions (15.5%). Anesthesia providers Ò Anesthesia providers work in a fast-paced environment where there is usually great emphasis placed on efciency , leaving little extra time for paying attention to infection control. cover story

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