Archive June 2016 XVII, No. 6

Infection Prevention: Can Anesthesia Providers Spread Infection?

Absolutely yes -- pay attention to what goes on at the head of the table.

Chuck Biddle, CRNA, PhD


anesthesia provider OVERWHELMED? It may be impossible for multi-tasking anesthesia providers to maintain total sterility, but increased awareness is a step in the right direction.

Many have long suspected that anesthesia providers play a significant role in the transmission of potentially pathogenic organisms during surgery. Now we know for sure. A study published recently in the Journal of the American Society of Anesthesiologists ( has essentially caught us in the act, underscoring both the challenges and the importance anesthesia providers face in striving for aseptic technique and preventing infections.

The researchers devised a clever way to measure how common the problem is. They had 23 anesthesiologists inject all bolus drugs used in 303 cases — except propofol and antibiotics — through a 0.2-micron filter designed to trap microorganisms. What they found was disturbing, if not altogether surprising. In 6.3% of the cases, the filters trapped potentially pathogenic microorganisms that would have reached patients. On top of that, when they cultured the insides of the syringe barrels, 16% were contaminated. Where did all the pathogenic organisms come from? In all likelihood, from a breach in technique that let them be transferred from such sources as the anesthesia workstation, the anesthesia provider's hands, the room or the patient.

syringe ENEMY WITHIN Researchers found that 16% of syringes were contaminated by microorganisms that could have reached patients.

Complex task
But while the disturbing findings speak to a need for improved techniques and heightened awareness, they also speak to the complexity and difficulty that anesthesia providers face when trying to engage in high-quality asepsis in the OR. The fact is, it's almost impossible to inject a drug sterilely into a patient during anesthetic care — unless, that is, it's the only job you have. But anesthesia providers have multiple jobs. And they aren't gowned and gloved the way surgeons are, and they're not operating in an area that has a dedicated laminar flow.

So, what's the answer? The study authors suggest that maybe we should routinely use those same 0.2-micron filters for injections. But the study participants rated ease of use with the filters as a 3.5 out of 10, with 0 being very easy and 10 being very difficult.

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