Einav Sharon, Wiener-Well Yonit
aThe Surgical Intensive Care Unit bThe Infectious Disease Unit, Shaare Zedek Medical Center and the Hebrew University, Faculty of Medicine, Jerusalem, Israel.
Curr Opin Anaesthesiol. 2017 Jun;30(3):426-434. doi: 10.1097/ACO.0000000000000457.
Up to 50% of specific bacterial strains in healthcare admission facilities are multi-drug resistant organisms (MDROs). Involvement of anesthesiologists in management of patients carrying/at risk of carrying MDROs may decrease transmission in the Operating Room (OR).
Anesthesiologists, their work area and tools have all been implicated in MDRO outbreaks. Causes include contamination of external ventilation circuits and noncontribution of filters to prevention, inappropriate decontamination procedures for nondisposable equipment (e.g. laryngoscopes, bronchoscopes and stethoscopes) and the anesthesia workplace (e.g. external surfaces of cart and anesthesia machine, telephones and computer keyboards) during OR cleaning and lack of training in sterile drug management.
Discussions regarding the management of potential MDRO carriers must include anesthesia providers to optimize infection control interventions as well as the anesthesia method, the location of surgery and recovery and the details of patient transport. Anesthesia staff must learn to identify patients at risk for MDRO infection. Antibiotic prophylaxis, although not evidence based, should adhere to known best practices. Adjuvant therapies (e.g. intranasal Mupirocin and bathing with antiseptics) should be considered. Addition of nonmanual OR cleaning methods such as ultraviolet irradiation or gaseous decontamination is encouraged. Anesthesiologists must undergo formal training in sterile drug preparation and administration.
在医疗入院设施中，高达50%的特定细菌菌株是多重耐药菌（MDROs）。麻醉医生参与携带/有携带MDROs风险患者的管理，可能会减少手术室（OR）中的传播。
麻醉医生、其工作区域和工具都与MDROs暴发有关。原因包括外部通气回路污染以及过滤器对预防无作用，手术室清洁期间对非一次性设备（如喉镜、支气管镜和听诊器）和麻醉工作场所（如推车和麻醉机的外表面、电话和电脑键盘）的去污程序不当，以及无菌药物管理方面缺乏培训。
关于潜在MDRO携带者管理的讨论必须包括麻醉人员，以优化感染控制干预措施，以及麻醉方法、手术和恢复的地点以及患者转运的细节。麻醉人员必须学会识别有MDRO感染风险的患者。抗生素预防措施虽然缺乏循证依据，但应遵循已知的最佳做法。应考虑辅助治疗（如鼻内使用莫匹罗星和用消毒剂沐浴）。鼓励增加非人工的手术室清洁方法，如紫外线照射或气体去污。麻醉医生必须接受无菌药物配制和给药方面的正规培训。
