Estimation of the contribution to intraoperative pathogen transmission from bacterial contamination of patient nose, patient groin and axilla, anesthesia practitioners' hands, anesthesia machine, and intravenous lumen
Authors' conclusion
To prevent intraoperative ESKAPE pathogen transmission, anesthesia practitioners would need to address all five categories of infection control approaches: nasal antisepsis (e.g., povidone-iodine applied the morning of surgery), skin antisepsis (e.g., chlorhexidine wipes), hand antisepsis with dispensers next to the patient, decontamination of the anesthesia machine before and during anesthetics, and disinfecting caps for needleless connectors, disinfecting port protectors, and disinfecting caps for open female Luer type connectors.
Study context
- Population
- ESKAPE pathogen transmission events within anesthesia areas of 86 operating rooms in nine hospitals over 43 months, between successive surgical cases in the same operating room on the same day
- Participants
- 448 transmission events
- Exposure
- Nose vs Groin or axilla vs Hands vs Anesthesia machine vs Intravenous lumen
- Outcome
- Contribution of each reservoir to ESKAPE pathogen transmission (proportion of case pairs)
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
Reservoir contributed to transmission (% of case pairs; 99% lower confidence limit)
Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| Reservoir started a transmission pathway (% of case pairs; 99% lower confidence limit) | Patient nose 27% (99% lower confidence limit ≥22%) · Patient groin or axilla 24% (99% lower confidence limit ≥19%) · Practitioners' hands 38% (99% lower confidence limit ≥33%) · Anesthesia machine 11% (99% lower confidence limit ≥7.6%) · IV lumen 8.0% (99% lower confidence limit ≥5.3%) |
- Reservoir started a transmission pathway (% of case pairs; 99% lower confidence limit): All P ≤ 0.0022 compared with 5%
Transmission events by pathogen
- S. aureus
- 203
- Enterococcus
- 72
- Gram negatives
- 173
Original publication
Estimation of the contribution to intraoperative pathogen transmission from bacterial contamination of patient nose, patient groin and axilla, anesthesia practitioners' hands, anesthesia machine, and intravenous lumen. J Clin Anesth. Published 22 October 2023. doi:10.
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