Hand Contamination from Anesthesiologists Linked to Bacterial Transmission During Surgery

Contaminating bacteria are very commonly found on the hands of anesthesia providers, with high rates of transmission to the surgical field during operations, reports a study in the January issue of Anesthesia & Analgesia, the journal of the International Anesthesia Research Society (IARS).

"As anesthesiologists, we like to think that the surgical drapes protect the patient from tens of trillions of microorganisms that are in and on our bodies," says Dr. Steven L. Shafer of Columbia University, editor-in-chief of Anesthesia & Analgesia. "Nope! These studies provide evidence that our bacterial flora contribute to surgical site infections."

Dr. Randy W. Loftus and colleagues of Dartmouth-Hitchcock Medical Center, Lebanon, N.H., performed a detailed study to determine the origin of bacteria transmitted to the surgical field in 164 operating room procedures using general anesthesia. Using culture tests, they found that bacteria were transmitted to the stopcock valves of the intravenous lines in 11.5 percent of procedures. In nearly half of these cases, the bacteria found in the intravenous lines were the same as those found on the hands of anesthesia providers: attending anesthesiologists, residents, and nurse-anesthetists.

Before the start of the procedure, contamination with potential disease-causing bacteria was found on the hands of anesthesia providers in 66 percent of cases. Overall, bacteria were transmitted to the intraoperative environment in 89 percent of procedures. In 12 percent of these cases, the source of the bacteria was the hands of anesthesia providers.

The study identified several factors associated with an increased risk of bacterial transmission. Transmission was more likely when the anesthesiologist had to supervise more than one room simultaneously, in older patients, and when the patient was sent directly from the operating room to the intensive care unit.

"Contamination of provider hands before patient carerepresents an important modifiable risk factor for bacterial cross-contamination," Loftus and colleagues write. "These findings support initiatives designed to improve intraoperative hand hygiene of anesthesia providers both before and during patient care, as well as intraoperative decontamination strategies."

A pair of accompanying editorials by Dr. Raymond C. Roy of Wake Forest University School of Medicine and co-authors provide important perspectives on the new findings. The editorialists emphasize the need not only to improve decontamination measures, but also to show that these steps help to meet the overarching goal of avoiding surgical infections. It may be that additional steps are necessary to reduce transmission of bacteria from the personal "microbiome" of trillions of microorganisms that each of us carries with uspatients and healthcare providers alike.

Yet there's little room for doubt that "abysmal" compliance with handwashing recommendations is a major contributor to the spread to surgical infections. "Although we know that handwashing is an important step, our compliance is poor, and there is little excuse for hospitals not implementing systems that facilitate compliance with handwashing guidelines," says Shafer. "However, as these reports suggest, it is time to look at additional measures to protect our patients from the biofilm that we take into the operating room every day."