The Most Important Measures in Reducing Infection Control in the Anesthesia Work Environment: An Evidence-Based Study
-
Younes Barazesh
,
Parisa Moradimajd
,
Azam Saei
,
Jamileh Abolghasemi
,
Mohammad-Mahdi Azizi-Darbandi
Abstract
Background: Anesthesia providers cross-contaminate their work environment. The hands of anesthesia providers are vectors for the transmission of infection between medical equipment in the anesthesia work environment and patients. The high work density of anesthesia providers around the patient has made it important to monitor infection control in the work environment and anesthesia procedures. This research aimed to find the best evidence for preventing or reducing infection in the anesthesia work environment.
Methods: The measures required for the guidelines in the field of infection control in the anesthesia work environment were determined according to the available resources and the use of expert opinions of anesthesiologists and faculty members. Then, the guidelines for infection control in the anesthesia work environment were designed based on the evidence-based method (Stettler model). Also, it has been implemented in a limited way in the operating room. To assess the validity of the approach used in calculating the content validity coefficient (CVR) and the content validity index (CVI), Finally, the Test-Retest method, and Cronbach's alpha coefficient were used to determine reliability.
Results: The guidelines for infection control in the anesthesia work environment were designed using evidence-based methods (Stettler's model). The content validity of anesthesia procedures requiring infection control guidelines was reported with a content validity index (CVI) of more than 0.79 and a content validity ratio (CVR) of more than 0.59. The reliability test was measured by Cronbach's alpha coefficient (0.806).
Conclusion: Based on this study, the use of global infection control guidelines changes the attitude of anesthesia nurses and reduces the rate of infection in the anesthesia work environment. Also, the use of evidence-based methods facilitates the implementation of guidelines in the target environment.
Bowdle A, Jelacic S, Shishido S, Munoz-Price LS. Infection prevention precautions for routine anesthesia care during the SARS-CoV-2 pandemic. Anesthesia & Analgesia. 2020; 131(5):1342-54.
[2] Dexter F, Loftus RW. Retrospective cohort study of anaesthesia machines shows low bacterial contamination can be achieved with surface disinfection. Br J Anaesth. 2023; 131(4):e109-e11.
[3] Macedo CE, Ferreira AM, Barcelos LDS, Alvim ALS, Carneiro LM, Martins SR, et al. Contamination of equipment and surfaces in the operating room anesthesia workspace: a cross-sectional study. Sao Paulo Med J. 2024; 142(4):e2023177.
[4] Porto AO, de Matos Leal CB, Ferreira RBS. Processo de enfermagem aplicado ao paciente com infecção de sítio cirúrgico pós-prostatectomia: relato de experiência. Revista Prevenção de Infecção e Saúde. 2018;4.
[5] Macedo CE. Contaminação de equipamentos e superfícies na área de trabalho de anestesia da sala de operação. 2022.
[6] Coté CJ, Lerman J, Todres ID. A practice of anesthesia for infants and children E-book: Expert consult: Online and print: Elsevier Health Sciences; 2012.
[7] Loftus RW, Brown JR, Koff MD, Reddy S, Heard SO, Patel HM, et al. Multiple reservoirs contribute to intraoperative bacterial transmission. Anesth Analg. 2012;114(6):1236-48.
[8] Koff MD, Brown JR, Marshall EJ, O'Malley AJ, Jensen JT, Heard SO, et al. Frequency of Hand Decontamination of Intraoperative Providers and Reduction of Postoperative Healthcare-Associated Infections: A Randomized Clinical Trial of a Novel Hand Hygiene System. Infect Control Hosp Epidemiol. 2016; 37(8):888-95.
[9] Loftus RW, Muffly MK, Brown JR, Beach ML, Koff MD, Corwin HL, et al. Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission. Anesth Analg. 2011; 112(1):98-105.
[10] Clark C, Taenzer A, Charette K, Whitty M. Decreasing contamination of the anesthesia environment. Am J Infect Control. 2014;42(11):1223-5.
[11] Mauldin PD, Salgado CD, Hansen IS, Durup DT, Bosso JA. Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant gram-negative bacteria. Antimicrob Agents Chemother. 2010; 54(1):109-15.
[12] Khademi Z. How to apply infection control practices in the delivery room. Hormozgan Med J. 2000; 3(2):24-9.
[13] Bagheri Nejad S, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection in Africa: a systematic review. Bull World Health Organ. 2011; 89(10):757-65.
[14] Mageda A S, Arafat AYM. The Effect of Evidence-Based Guidelines on Nurses, Performance in Respect to Nosocomial Infection at Medical-Surgical and Obstetrician Departments. 2018.
[15] Arafat M, Mahdy A, Elkashif M. The Effect of Evidence-Based Guidelines on Nurses, Performance in Respect to Nosocomial Infection at Medical-Surgical and Obstetrician Departments. American Journal of Nursing Research. 2018; 6:507-14.
[16] Loftus RW, Koff MD, Birnbach DJ. The dynamics and implications of bacterial transmission events arising from the anesthesia work area. Anesth Analg. 2015;120(4):853-60.
[17] Martin LD, Rampersad SE, Geiduschek JM, Zerr DM, Weiss GK, Martin LD. Modification of anesthesia practice reduces catheter-associated bloodstream infections: a quality improvement initiative. Paediatr Anaesth. 2013; 23(7):588-96.
[18] Munoz-Price LS, Bowdle A, Johnston BL, Bearman G, Camins BC, Dellinger EP, et al. Infection prevention in the operating room anesthesia work area. Infect Control Hosp Epidemiol. 2019; 40(1):1-17.
[19] Anesthesiology AAoN. Infection Prevention and Control Guidelines for Anesthesia Care. 2018.
[20] Plemmons MM, Marcenaro J, Oermann MH, Thompson J, Vacchiano CA. Improving infection control practices of nurse anesthetists in the anesthesia workspace. Am J Infect Control. 2019; 47(5):551-7.
[21] Marais R. Guidelines for infection control and prevention in anaesthesia in South Africa. Southern African Journal of Anaesthesia and Analgesia. 2021;27(4):S1-S55.
[22] Loftus R, Koff M, Burchman C, Schwartzman J, Thorum V, Read M, et al. Transmission of Pathogenic Bacterial Organisms in the Anesthesia Work Area. Anesthesiology. 2008; 109:399-407.
[23] Porteous GH, Bean HA, Woodward CM, Beecher RP, Bernstein JR, Wilkerson S, et al. A Simulation Study to Evaluate Improvements in Anesthesia Work Environment Contamination After Implementation of an Infection Prevention Bundle. Anesth Analg. 2018; 127(3):662-70.
[24] Munoz-Price LS, Bowdle A, Johnston BL, Bearman G, Camins BC, Dellinger EP, et al. Infection prevention in the operating room anesthesia work area. Infect Control Hosp Epidemiol. 2019; 40(1):1-17.
[25] WHO guidelines on hand hygiene in health care. www.who.int2009.
[26] Munoz-Price LS, Birnbach DJ. Hand Hygiene and Anesthesiology. Int Anesthesiol Clin. 2013; 51(1):79-92.
[27] Association of Anaesthetists of Great Britain and Ireland. Infection control in anaesthesia. Anaesthesia. 2008; 63(9):1027-36.
[28] Dolan SA, Arias KM, Felizardo G, Barnes S, Kraska S, Patrick M, et al. APIC position paper: Safe injection, infusion, and medication vial practices in health care. Am J Infect Control. 2016;44(7):750-7.
[29] Content source: Centers for Disease Control and Prevention NCfEaZIDN, Division of High-Consequence Pathogens and Pathology (DHCPP). https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html. 2022.
[30] Centers for Disease Control and Prevention NCfEaZIDN, Division of Healthcare Quality Promotion (DHQP). Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Centre for Disease Control and Prevention; 2007. 2007.
[31] Negri de Sousa AC, Levy CE, Freitas MI. Laryngoscope blades and handles as sources of cross-infection: an integrative review. J Hosp Infect. 2013;83(4):269-75.
[32] Negri de Sousa AC, Vilas Boas VA, Levy CE, Pedreira de Freitas MI. Laryngoscopes: Evaluation of microbial load of blades. Am J Infect Control. 2016; 44(3):294-8.
[33] Esler MD, Baines LC, Wilkinson DJ, Langford RM. Decontamination of laryngoscopes: a survey of national practice. Anaesthesia. 1999; 54(6):587-92.
[34] Simmons SA. Laryngoscope handles: a potential for infection. Aana j. 2000; 68(3):233-6.
[35] Williams D, Dingley J, Jones C, Berry N. Contamination of laryngoscope handles. J Hosp Infect. 2010; 74(2):123-8.
[36] Call TR, Auerbach FJ, Riddell SW, Kiska DL, Thongrod SC, Tham SW, et al. Nosocomial contamination of laryngoscope handles: challenging current guidelines. Anesth Analg. 2009; 109(2):479-83.
[37] Yee KF. Decontamination issues and perceived reliability of the laryngoscope--a clinician's perspective. Anaesth Intensive Care. 2003; 31(6):658-62.
[38] Williams D, Dingley J, Jones C, Berry N. Contamination of laryngoscope handles. The J Hosp Infect. 2010; 74:123-8.
[39] Muscarella LF. Recommendations to resolve inconsistent guidelines for the reprocessing of sheathed and unsheathed rigid laryngoscopes. Infect Control Hosp Epidemiol. 2007; 28(4):504-7.
[40] Van Wicklin SA. Contamination and Disinfection of Rigid Laryngoscopes: A Literature Review. Aorn j. 2019; 110(1):49-59.
[41] Kalra P. Miller's Anesthesia, Volumes 1 and 2, 7th Edition. Anesthesiology. 2010;112(1):260-1.
[42] Karlet M GM, Grace Ford M, Manju M, Griffis C. Infection Control: It's Everyone'sBusiness. 2014.
[43] Biddle C, Shah J. Quantification of anesthesia providers' hand hygiene in a busy metropolitan operating room: what would Semmelweis think? Am J Infect Control. 2012; 40(8):756-9.
[44] Rowlands J, Yeager MP, Beach M, Patel HM, Huysman BC, Loftus RW. Video observation to map hand contact and bacterial transmission in operating rooms. Am J Infect Control. 2014;42(7):698-701.
[45] Loftus RW, Koff MD, Birnbach DJ. The dynamics and implications of bacterial transmission events arising from the anesthesia work area. Anesthesia & Analgesia. 2015; 120(4):853-60.
[46] Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA. Hand washing promotion for preventing diarrhoea. Cochrane Database Syst Rev. 2015; 2015(9):Cd004265.
[47] Helms B, Dorval S, St Laurent P, Winter M. Improving hand hygiene compliance: A multidisciplinary approach. Am J Infect Control. 2010; 38:572-4.
[48] Plemmons MM, Marcenaro J, Oermann MH, Thompson J, Vacchiano CA. Improving infection control practices of nurse anesthetists in the anesthesia workspace. Am J Infect Control. 2019;47(5):551-7.
[2] Dexter F, Loftus RW. Retrospective cohort study of anaesthesia machines shows low bacterial contamination can be achieved with surface disinfection. Br J Anaesth. 2023; 131(4):e109-e11.
[3] Macedo CE, Ferreira AM, Barcelos LDS, Alvim ALS, Carneiro LM, Martins SR, et al. Contamination of equipment and surfaces in the operating room anesthesia workspace: a cross-sectional study. Sao Paulo Med J. 2024; 142(4):e2023177.
[4] Porto AO, de Matos Leal CB, Ferreira RBS. Processo de enfermagem aplicado ao paciente com infecção de sítio cirúrgico pós-prostatectomia: relato de experiência. Revista Prevenção de Infecção e Saúde. 2018;4.
[5] Macedo CE. Contaminação de equipamentos e superfícies na área de trabalho de anestesia da sala de operação. 2022.
[6] Coté CJ, Lerman J, Todres ID. A practice of anesthesia for infants and children E-book: Expert consult: Online and print: Elsevier Health Sciences; 2012.
[7] Loftus RW, Brown JR, Koff MD, Reddy S, Heard SO, Patel HM, et al. Multiple reservoirs contribute to intraoperative bacterial transmission. Anesth Analg. 2012;114(6):1236-48.
[8] Koff MD, Brown JR, Marshall EJ, O'Malley AJ, Jensen JT, Heard SO, et al. Frequency of Hand Decontamination of Intraoperative Providers and Reduction of Postoperative Healthcare-Associated Infections: A Randomized Clinical Trial of a Novel Hand Hygiene System. Infect Control Hosp Epidemiol. 2016; 37(8):888-95.
[9] Loftus RW, Muffly MK, Brown JR, Beach ML, Koff MD, Corwin HL, et al. Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission. Anesth Analg. 2011; 112(1):98-105.
[10] Clark C, Taenzer A, Charette K, Whitty M. Decreasing contamination of the anesthesia environment. Am J Infect Control. 2014;42(11):1223-5.
[11] Mauldin PD, Salgado CD, Hansen IS, Durup DT, Bosso JA. Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant gram-negative bacteria. Antimicrob Agents Chemother. 2010; 54(1):109-15.
[12] Khademi Z. How to apply infection control practices in the delivery room. Hormozgan Med J. 2000; 3(2):24-9.
[13] Bagheri Nejad S, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection in Africa: a systematic review. Bull World Health Organ. 2011; 89(10):757-65.
[14] Mageda A S, Arafat AYM. The Effect of Evidence-Based Guidelines on Nurses, Performance in Respect to Nosocomial Infection at Medical-Surgical and Obstetrician Departments. 2018.
[15] Arafat M, Mahdy A, Elkashif M. The Effect of Evidence-Based Guidelines on Nurses, Performance in Respect to Nosocomial Infection at Medical-Surgical and Obstetrician Departments. American Journal of Nursing Research. 2018; 6:507-14.
[16] Loftus RW, Koff MD, Birnbach DJ. The dynamics and implications of bacterial transmission events arising from the anesthesia work area. Anesth Analg. 2015;120(4):853-60.
[17] Martin LD, Rampersad SE, Geiduschek JM, Zerr DM, Weiss GK, Martin LD. Modification of anesthesia practice reduces catheter-associated bloodstream infections: a quality improvement initiative. Paediatr Anaesth. 2013; 23(7):588-96.
[18] Munoz-Price LS, Bowdle A, Johnston BL, Bearman G, Camins BC, Dellinger EP, et al. Infection prevention in the operating room anesthesia work area. Infect Control Hosp Epidemiol. 2019; 40(1):1-17.
[19] Anesthesiology AAoN. Infection Prevention and Control Guidelines for Anesthesia Care. 2018.
[20] Plemmons MM, Marcenaro J, Oermann MH, Thompson J, Vacchiano CA. Improving infection control practices of nurse anesthetists in the anesthesia workspace. Am J Infect Control. 2019; 47(5):551-7.
[21] Marais R. Guidelines for infection control and prevention in anaesthesia in South Africa. Southern African Journal of Anaesthesia and Analgesia. 2021;27(4):S1-S55.
[22] Loftus R, Koff M, Burchman C, Schwartzman J, Thorum V, Read M, et al. Transmission of Pathogenic Bacterial Organisms in the Anesthesia Work Area. Anesthesiology. 2008; 109:399-407.
[23] Porteous GH, Bean HA, Woodward CM, Beecher RP, Bernstein JR, Wilkerson S, et al. A Simulation Study to Evaluate Improvements in Anesthesia Work Environment Contamination After Implementation of an Infection Prevention Bundle. Anesth Analg. 2018; 127(3):662-70.
[24] Munoz-Price LS, Bowdle A, Johnston BL, Bearman G, Camins BC, Dellinger EP, et al. Infection prevention in the operating room anesthesia work area. Infect Control Hosp Epidemiol. 2019; 40(1):1-17.
[25] WHO guidelines on hand hygiene in health care. www.who.int2009.
[26] Munoz-Price LS, Birnbach DJ. Hand Hygiene and Anesthesiology. Int Anesthesiol Clin. 2013; 51(1):79-92.
[27] Association of Anaesthetists of Great Britain and Ireland. Infection control in anaesthesia. Anaesthesia. 2008; 63(9):1027-36.
[28] Dolan SA, Arias KM, Felizardo G, Barnes S, Kraska S, Patrick M, et al. APIC position paper: Safe injection, infusion, and medication vial practices in health care. Am J Infect Control. 2016;44(7):750-7.
[29] Content source: Centers for Disease Control and Prevention NCfEaZIDN, Division of High-Consequence Pathogens and Pathology (DHCPP). https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html. 2022.
[30] Centers for Disease Control and Prevention NCfEaZIDN, Division of Healthcare Quality Promotion (DHQP). Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Centre for Disease Control and Prevention; 2007. 2007.
[31] Negri de Sousa AC, Levy CE, Freitas MI. Laryngoscope blades and handles as sources of cross-infection: an integrative review. J Hosp Infect. 2013;83(4):269-75.
[32] Negri de Sousa AC, Vilas Boas VA, Levy CE, Pedreira de Freitas MI. Laryngoscopes: Evaluation of microbial load of blades. Am J Infect Control. 2016; 44(3):294-8.
[33] Esler MD, Baines LC, Wilkinson DJ, Langford RM. Decontamination of laryngoscopes: a survey of national practice. Anaesthesia. 1999; 54(6):587-92.
[34] Simmons SA. Laryngoscope handles: a potential for infection. Aana j. 2000; 68(3):233-6.
[35] Williams D, Dingley J, Jones C, Berry N. Contamination of laryngoscope handles. J Hosp Infect. 2010; 74(2):123-8.
[36] Call TR, Auerbach FJ, Riddell SW, Kiska DL, Thongrod SC, Tham SW, et al. Nosocomial contamination of laryngoscope handles: challenging current guidelines. Anesth Analg. 2009; 109(2):479-83.
[37] Yee KF. Decontamination issues and perceived reliability of the laryngoscope--a clinician's perspective. Anaesth Intensive Care. 2003; 31(6):658-62.
[38] Williams D, Dingley J, Jones C, Berry N. Contamination of laryngoscope handles. The J Hosp Infect. 2010; 74:123-8.
[39] Muscarella LF. Recommendations to resolve inconsistent guidelines for the reprocessing of sheathed and unsheathed rigid laryngoscopes. Infect Control Hosp Epidemiol. 2007; 28(4):504-7.
[40] Van Wicklin SA. Contamination and Disinfection of Rigid Laryngoscopes: A Literature Review. Aorn j. 2019; 110(1):49-59.
[41] Kalra P. Miller's Anesthesia, Volumes 1 and 2, 7th Edition. Anesthesiology. 2010;112(1):260-1.
[42] Karlet M GM, Grace Ford M, Manju M, Griffis C. Infection Control: It's Everyone'sBusiness. 2014.
[43] Biddle C, Shah J. Quantification of anesthesia providers' hand hygiene in a busy metropolitan operating room: what would Semmelweis think? Am J Infect Control. 2012; 40(8):756-9.
[44] Rowlands J, Yeager MP, Beach M, Patel HM, Huysman BC, Loftus RW. Video observation to map hand contact and bacterial transmission in operating rooms. Am J Infect Control. 2014;42(7):698-701.
[45] Loftus RW, Koff MD, Birnbach DJ. The dynamics and implications of bacterial transmission events arising from the anesthesia work area. Anesthesia & Analgesia. 2015; 120(4):853-60.
[46] Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA. Hand washing promotion for preventing diarrhoea. Cochrane Database Syst Rev. 2015; 2015(9):Cd004265.
[47] Helms B, Dorval S, St Laurent P, Winter M. Improving hand hygiene compliance: A multidisciplinary approach. Am J Infect Control. 2010; 38:572-4.
[48] Plemmons MM, Marcenaro J, Oermann MH, Thompson J, Vacchiano CA. Improving infection control practices of nurse anesthetists in the anesthesia workspace. Am J Infect Control. 2019;47(5):551-7.
| Files | ||
| Issue | Vol 11 No 1 (2025): Winter |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v11i1.17487 | |
| Keywords | ||
| Anesthesia work environment Infection prevention Standard precautions | ||
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How to Cite
1.
Barazesh Y, Moradimajd P, Saei A, Abolghasemi J, Azizi-Darbandi M-M. The Most Important Measures in Reducing Infection Control in the Anesthesia Work Environment: An Evidence-Based Study. Arch Anesth & Crit Care. 2024;11(1):29-36.
