Archive October 2013 XIV, No. 10

Is There an Infection Risk At the Head of the Table?

There might be if your anesthesia providers are practicing poor hand hygiene.

Chuck Biddle, CRNA, PhD


anesthesia providers DIFFERING VIEWS Do you agree that anesthesia providers are often much less aware than surgeons and nurses regarding accepted aseptic practices?

You might not worry about your anesthesia providers spreading infections, but they can harm patients downstream from what they do. Recent research ( strongly suggests it's time to pay more attention to the men and women at the head of the table. Ask yourself:

  • Do your anesthetists wipe down the laryngoscope handles between cases, or do they throw them right back in the drawer?
  • Do they put gloves on to start an IV? (Putting a glove on 1 hand doesn't count.)
  • Do they disinfect their hands, both as a matter of routine throughout procedures and whenever there's an indication to do so (after airway manipulation, for example)?
  • Do they change gloves frequently?

If you answered "no" to any of these questions, chalk it up to what I call "normalized deviance." That is, providers may recognize that what they're doing is wrong, or at least less than optimal, but because everybody else is doing it, it becomes a normal part of daily practice. And the fact that infections typically occur in the aftermath of when anesthesia providers see patients can cause any sense of responsibility to pass under their radar.

Just how bad is the problem?
In one study we did (, we had people in the OR masquerading as nurses in training. But they were actually there to watch the anesthesia providers throughout the perioperative continuum. What they saw was more than 80% failed at hand hygiene.

One key is to make it as easy as possible for providers to wash their hands, which may be needed a dozen or more times an hour, research shows. Consider personal hand sanitizers — devices that can be clipped onto scrubs and programmed to remind you to clean your hands every so often. If you both remind people and provide an ergonomically efficient way to do that, their rate of engaging in hand hygiene increases. Amazingly, established research shows that the rate of post-operative infection goes down.

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