Hand hygiene and aseptic techniques during routine anesthetic care - observations in the operating room

Abstract

BackgroundMore knowledge is needed about task intensity in relation to hand hygiene in the operating room during anesthetic care in order to choose effective improvement strategies. The aim of this study was to explore the indications and occurrence of hand hygiene opportunities and the adherence to hand hygiene guidelines during routine anesthetic care in the operating room.MethodsStructured observational data on hand hygiene during anesthetic care during 94 surgical procedures was collected using the World Health Organization’s observational tool in a surgical department consisting of 16 operating rooms serving different surgical specialties such as orthopedic, gynecological, urological and general surgery.ResultsA total of 2,393 opportunities for hand hygiene was recorded. The number of hand hygiene opportunities when measured during full-length surgeries was mean = 10.9/hour, SD 6.1 with an overall adherence of 8.1%. The corresponding numbers for the induction phase were, mean =77.5/h, SD 27.4 with an associated 3.1% adherence to hand hygiene guidelines. Lowest adherence was observed during the induction phase before an aseptic task (2.2%) and highest during full-length surgeries after body fluid exposure (15.9%).ConclusionsThere is compelling evidence for low adherence to hand hygiene guidelines in the operating room and thus an urgent need for effective improvement strategies. The conclusion of this study is that any such strategy should include education and practical training in terms of how to carry out hand hygiene and aseptic techniques and how to use gloves correctly. Moreover it appears to be essential to optimize the work processes in order to reduce the number of avoidable hand hygiene opportunities thereby enhancing the possibilities for adequate use of HH during anesthetic care.

Breath alcohol of anesthesiologists using alcohol hand gel and the “five moments for hand hygiene” in routine practice

“…Nevertheless, the number of HHOs completed in this study is consistent with data reported for anesthesiologists in other studies. [6][7][8] Third, most participants remarked that, by following the ''five moments'' prescription, they used alcohol hand gel more frequently than they typically would in their usual practice. It follows that positive breathalyzer tests may be less likely than our data suggest when anesthesiologists invoke their usual hand hygiene habits.…”

“…[2][3][4][5] The feasibility of applying this standard when administering an anesthetic has been challenged. [6][7][8] Compliance is frequently poor in anesthetic environments, even if convenient alcohol hand gel preparations are used. [6][7][8][9][10] Nevertheless, it is the policy of hospital administrators and the Health Quality & Safety Commission New Zealand that all healthcare workers comply with the five moments approach.…”

“…[6][7][8] Compliance is frequently poor in anesthetic environments, even if convenient alcohol hand gel preparations are used. [6][7][8][9][10] Nevertheless, it is the policy of hospital administrators and the Health Quality & Safety Commission New Zealand that all healthcare workers comply with the five moments approach. 5 Systemic alcohol absorption is a potential unintended consequence of the high number of hand gel applications required to comply with the five moments when giving an anesthetic.…”

Hand Contamination, Cross‐Transmission, and Risk‐Associated Behaviors: An Observational Study of Team Members in ORs

“…Patients undergoing surgical procedures are exposed to multiple risks for HAIs during the use or insertion of invasive medical devices, and these risks increase with poor hand hygiene practices 5 . Previously, we carried out a study in the OR that showed alarmingly low (5.3%) adherence to hand hygiene guidelines 6 . This motivated us to carry out the present study.…”

Improving care in surgery – a qualitative study of managers’ experiences of implementing evidence-based practice in the operating room

“…[12][13][14][15] Preventive innovations such as the correct timing, type and dose of prophylactic antibiotics have in many cases been reported to be suboptimal. [16][17][18][19] In addition, ample evidence exists for deficits in hand hygiene during anesthetic care, [20][21][22][23][24] intraoperative patient warming during surgery, [19] and restricted traffic flow during surgical procedures. [25][26][27][28] These results show a substantial "knowdo gap" [29] between what is known about safe and effective practice and what is actually done in the OR, supporting an urgent need for implementing evidence-based practice for preventive innovations in order to enhance the safety of patients.…”