Rowlands John, Yeager Mark P, Beach Michael, Patel Hetal M, Huysman Bridget C, Loftus Randy W
Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Departments of Anesthesiology and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Am J Infect Control. 2014 Jul;42(7):698-701. doi: 10.1016/j.ajic.2014.02.021.
Hand hygiene (HH) is considered a primary intervention to avoid transmission of bacteria in health care settings and to prevent health care-associated infections. Despite efforts to decrease the incidence of health care-associated infections by improving HH, HH compliance rates vary widely depending on the hospital environment.
We used intraoperative video observation to map temporal patterns of anesthesia provider hand contact with anesthesia work environment (AWE) surfaces and to assess HH compliance. Serial bacterial cultures of high contact objects were subsequently used to characterize bacterial transmission over time.
Using World Health Organization criteria, we found a large number of HH opportunities and a low rate of HH compliance by anesthesia providers (mean, 2.9%). We observed an inverse correlation between provider hand hygiene compliance during induction and emergence from anesthesia (3.2% and 4.1%, respectively) and the magnitude of AWE surface contamination (103 and 147 CFU, respectively) at these time points. We found no correlation between frequency of hand contact with the AWE and bacterial contamination.
Compliance with current HH recommendations by anesthesia providers is not feasible. However, there does appear to be a correlation between HH compliance rates and bacterial contamination of the AWE, an observation that should stimulate further work to design new methods for control of bacterial transmission in operating rooms.
手部卫生（HH）被视为在医疗环境中避免细菌传播以及预防医疗相关感染的主要干预措施。尽管通过改善手部卫生来降低医疗相关感染发生率已做出诸多努力，但手部卫生的依从率因医院环境不同而差异很大。
我们使用术中视频观察来绘制麻醉医护人员手部与麻醉工作环境（AWE）表面接触的时间模式，并评估手部卫生的依从性。随后，对高接触物体进行连续细菌培养，以表征随时间的细菌传播情况。
根据世界卫生组织的标准，我们发现麻醉医护人员有大量的手部卫生机会，但手部卫生依从率较低（平均为2.9%）。我们观察到，在麻醉诱导期和苏醒期医护人员的手部卫生依从性（分别为3.2%和4.1%）与这些时间点AWE表面的污染程度（分别为103和147 CFU）之间呈负相关。我们发现手部与AWE接触频率和细菌污染之间没有相关性。
麻醉医护人员遵守当前手部卫生建议并不可行。然而，手部卫生依从率与AWE的细菌污染之间似乎确实存在相关性，这一观察结果应促使开展进一步工作，以设计控制手术室细菌传播的新方法。
