Hand Contamination of Anesthesia Providers Is an Important Risk Factor for Intraoperative Bacterial Transmission

Multiple Reservoirs Contribute to Intraoperative Bacterial Transmission

“…Reservoir isolates were then compared to stopcock bacterial isolates and the origin determined via standard microbiological techniques, biotype analysis, and temporal association (timing of transmission events linked to an appropriate reservoir exposure) using a previously validated protocol (see below). 12,13 The sequence of sample acquisition events is detailed in Figure 1.…”

“…Previously sterile stopcock sets were cultured at case end for both case 1 and case 2 of each of 274 case pairs. Bacterial reservoirs including provider hands throughout patient care, patients, and the anesthesia machine adjustable pressure-limiting (APL) valve and vaporizer agent dial, proven representatives of the intraoperative patient environment, [12][13][14] were sampled in parallel throughout the process of intraoperative patient care for both operative cases. Reservoir isolates were then compared to stopcock bacterial isolates and the origin determined via standard microbiological techniques, biotype analysis, and temporal association (timing of transmission events linked to an appropriate reservoir exposure) using a previously validated protocol (see below).…”

“…Studies have shown that intraoperative bacterial contamination of patient IV stopcock sets is common and is related to bacterial contamination of anesthesia provider hands before patient care. [12][13][14] However, the relative contributions of other known intraoperative bacterial reservoirs including the patient, the patient environment, and provider hand contamination throughout the process of patient care to stopcock transmission have not been characterized. The primary aim of the current study was to examine these relationships.…”

Is Surgical Case Order Associated With Increased Infection Rate After Spine Surgery?

“…A study at Dartmouth-Hitchcock Medical Center after bacterial transmission in the operating room found that the fi rst case of the day is associated with a higher magnitude of transmission by anesthesia providers. 28 In addition, it is possible that the buildup of contaminants that occurs during the fi rst case is carried over and amplifi ed during subsequent cases. For example, the same Dartmouth study found that (with 0% as the baseline for case 1), 7% of operating rooms analyzed had a contaminated environment before the start of case 2.…”

“…24 , 28 Despite efforts to decontaminate the operating room between cases, a study found that 7% remained contaminated at the start of case number 2. 28 Flash sterilization has also been found to increase perioperative wound infections and happens more commonly later in the day. 29 To date, no study has investigated the relationship between slot time of surgery and infection risk in the postoperative period.…”