How Often Should Anesthesia Providers Wash Hands?

While we may not like to hear it, the fact that anesthesia providers play a significant role in the transmission of serious infections to the patients under our care is well established. The question is, how can we effectively reduce the introduction of pathogens to our patients? I've not seen a study that answers this question.

The July issue of the American Journal of Infection Control (www.ajicjournal.org) includes a study that both defines just how big the problem is and verifies that current solutions are impossible for anesthesia providers to comply with (Video observation to map hand contact and bacterial transmission in operating rooms). In this study the investigators used a combination of video monitoring and bacterial cultures to define bacterial transmission throughout the course of an anesthetic. Two of their findings should be of intense interest to anesthesia:

Compliance with current HH [Hand Hygiene] recommendations by anesthesia providers is not feasible.
— Study Authors

1) Efforts of anesthesia providers to clean their hands were inversely correlated with bacterial contamination (no surprise).

2) On average, there were 149 times an hour when hand cleaning was called for by current WHO guidelines. Simply put, full compliance with hand hygiene guidelines would have taken more than 60 minutes to perform during each hour of anesthesia time.

Clearly, infection of patients during surgery by anesthesia providers is an important problem. Just as clearly, current recommendations to prevent the spread of infection are impossible to perform in their entirety, and the investigators made this point.

Anesthesia providers play a crucial role in the spread of pathogens to our patients, but at this point effective methods to prevent the spread of infection have not been identified. Hand hygiene is important and we should continue to clean our hands frequently. We may not be able to solve the problem with hand washing, but we can reduce the problem with hand hygiene and equipment disinfection until we have a more comprehensive solution.

NOTES: World Health Organization guidelines for Hand Hygiene http://whqlibdoc.who.int/hq/2009/who_ier_psp_2009.07_eng.pdf

Perform hand hygiene:

  1. before and after touching the patient
  2. before handling an invasive device for patient care regardless of whether or not gloves are used
  3. after contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings
  4. if moving from a contaminated body site to another body site during care of the same patient
  5. after contact with inanimate surfaces and objects (including medical equipment) in the immediate vicinity of the patient

  6. after removing sterile or non-sterile gloves