Ideas to reduce OR contamination

Ideas to reduce OR contamination

Simple remedies — from keeping the antibacterial gel dispenser clean to giving health care workers their own hand sanitizer — can help keep patients safe by decreasing contamination in operating and recovery rooms, suggest two studies presented at the Anesthesiology 2013 annual meeting.

Keeping hand sanitizer dispensers clean decreases their bacterial contamination by 75%, while healthcare workers with personal gel bottles attached to their belts were nearly 30% more likely to use the hand sanitizer, the studies found.

The studies investigated operating room contamination and resulted in common sense remedies to increase sanitization. The first study looked at bacterial counts on such high-touch surfaces as the hand sanitizer dispenser and the electronic medical record keyboard. The second study followed the compliance of a hand hygiene policy before and after personal sanitation gel devices were worn on the belts of medical personnel.

"Perioperative infection and contamination is a serious threat to patient safety," said Devon C. Cole, MD, anesthesiologist in the Department of Anesthesiology, University of Florida, Gainesville. "The hand sanitizer is touched to sanitize a presumably unsanitary hand and is therefore uniquely vulnerable to contamination. It just made sense to measure the bacteria on the dispenser handles of these containers."

Bacteria on sanitizer dispensers were sampled at four-hour intervals at two hospitals during the work day and also at 5 a.m. and 8 p.m. At the first hospital, all the hand sanitizer dispensers were cleaned with a germicidal disposable wipe after each patient was discharged. At the second hospital, no disinfection of the dispensers was done.

Hand sanitizer dispensers accumulated a rising number of bacteria throughout the day at both hospitals. However the number of bacterial colony-forming units at the second hospital was significantly higher. At 5 a.m. and 8 p.m., there was an average of one bacterial unit. At the end of the day, an average of 93 bacterial units had accumulated on the dispensers. At the first hospital, the number of bacterial units rose from one at 5 a.m. to 23 at 6 p.m., significantly less than hospital number two.

"Often the last object touched by the anesthesia provider before the patient’s IV is the hand sanitizer dispenser," explained Cole. "Too small a volume of sanitizer, inadequate coverage of finger tips, and a short drying time will all enable bacteria to persist on the providers’ hands. Routine cleansing of the dispensers will reduce this reservoir of bacteria. Decontamination of the dispenser should be an important part of anesthesia workstation cleaning."

In the second study, attending physicians, fellows, residents, and nurses were observed for compliance with the hand hygiene policy before and after they were given a personal sanitation gel dispensing device to be worn on their belts. Next, compliance rates with and without the personal sanitation gel dispenser were compared.

Colby L. Parks, MD, anesthesiologist in the Department of Anesthesia at the University of Wisconsin, Madison, said, "Despite the availability of wall-mounted hand sanitation dispensers, compliance was less than ideal. This study shows that a simple intervention in which a personal antibacterial hand gel dispenser is readily available, works better for a busy healthcare provider’s workflow pattern, presumably leading to decreased patient and surrounding-care-area contamination."

The study found that the overall compliance with the hand hygiene protocol after the implementation of personal gel dispensers increased 29%. More than 307 encounters were observed. In the 146 encounters prior to the implementation of the personal gel dispensers, compliance for pre- and post-patient contact hand hygiene was 23% and 43%, respectively. For the 161 encounters after the individual gel dispensers were provided, the compliance for pre- and post-patient contact was 53% and 72%, respectively. (For more infection control coverage from the Anesthesiology meeting, see our tweets @SameDaySurgery Oct. 13-17, 2103.)