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Anesthesia Hand Hygiene Compliance is Least When Needed Most

Providers wash hands less often during induction and emergence.

Published: July 1, 2014

During surgery, anesthesia providers are more likely to wash their hands during periods of time when there's less threat of bacterial contamination, and less likely when the threat is greater, a study published in the July issue of the American Journal of Infection Control suggests. The study also notes that it would be impossible for providers to completely comply with hand hygiene practices recommended by the World Health Organization (WHO), because there isn't enough time to do so.

The study involved 2 sets of surgical procedures, with 5 surgeries in each. During the first set, researchers observed that the lowest compliance rates came during what were defined as the induction phases (the first 20 minutes of each) and the emergence phases (the last 20 minutes). The highest compliance rates came during the 30-minute period between induction and emergence.

During the second set of procedures, the researchers took cultures at various intervals from 20 surfaces that had been identified during the first set as those in the anesthesia work environment that were most frequently touched — the bed, the pen, the anesthesia cart second drawer handle and so on. They found that the sharpest increases in contamination occurred "during the complex and rapidly evolving induction and emergence phases," the times when anesthesia providers find it most challenging to follow hand hygiene guidelines and are least likely to do so.

WHO guidelines specify 5 hand-hygiene moments: (1) before touching a patient; (2) before a clean procedure; (3) after exposure to body fluids; (4) after touching a patient; and (5) after touching a patient's surroundings. Providers were most likely to wash their hands after a potential body fluid exposure, and least likely before patient contact or after contact with the environment. The researchers note, however, that the mean total number of WHO opportunities observed per hour was 149, meaning that total compliance would have consumed more time than was available.

The results, say the authors, suggest that improving compliance "may require development and implementation of novel approaches."

Jim Burger

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