Keeping our Hands Clean During Anesthesia

I've been watching studies about hand washing and transmission of infections or infectious organisms to surgical patients by the anesthesia provider for several years now. What is clear is that patients do become infected, sometimes septic, and sometimes die as a result of organisms on anesthesia equipment and/or the hands or gloves of the anesthesia provider. These organisms often come from the patient's own skin but would not have entered their body without our help. I think we can all agree that this is an important problem.

How do we effectively reduce patient morbidity and mortality from infections carried by the hands of the anesthesia team? The traditional infection control answer is to wear gloves, change gloves often, and wash or sanitize our hands after every patient contact. But therein lies the problems for anesthesia. Our contact is not intermittent; it is continuous. An even bigger problem, however, is that multiple studies have identified an unobtainable number of times anesthesia providers "should" wash or sanitize our hands under current guidelines. The latest study I've seen recorded an average number of times during induction of anesthesia when "hand hygiene" was required as a whopping 77.5 times an hour. (Hand hygiene and aseptic techniques during routine anesthetic care - observations in the operating room. Antimicrobial Resistance and Infection Control 2015, 4:5) Induction doesn't normally last an hour. I get that. So think of this as 6.5 times during a 5 minute induction. I think we can all agree that it isn't possible to take care of the patient and clean your hands more often than once a minute during a critical period such as induction. As I see it that leaves us at the point of hand hygiene recommendations that are impossible to satisfy.

What do we do? Give up? Forget about hand hygiene and don't worry about it? Certainly not. We can and should get better at hand hygiene and get closer to satisfying the guidelines. But since we know it is not possible to satisfy them completely, we need to begin thinking about novel ways, ways we've never considered before, to dramatically reduce the contamination of anesthesia equipment and dramatically reduce the transmission of pathogens from our hands to the patient; especially through an IV and to mucous membranes.

Problems like this benefit from quality research and it may be tempting to sit back and wait for the researchers to solve the problem and tell us what to do. That would be a mistake. Research has defined the problem. We are the ones who are there with the patient for hours each day. We can contribute to the pool of ideas on how to reduce patient infectious morbidity and mortality by making careful observations and thinking. Don't worry about having a bad idea. We will collect 1,000 ideas. Only one of them has to be a good idea to make everyone's time worth while. Please join in the process. 

Michael A. Fiedler, PhD, CRNA