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A N E S T H E S I A
&
I N F E C T I O N S
• Do they disinfect their hands, both as a matter of routine throughout
procedures and whenever there's an indication to do so (after airway
manipulation, for example)?
• Do they change gloves frequently?
If you answered "no" to any of these questions, chalk it up to what I
call "normalized deviance." That is, providers may recognize that what
they're doing is wrong, or at least less than optimal, but because
everybody else is doing it, it becomes a normal part of daily practice.
And the fact that infections typically occur in the aftermath of when
anesthesia providers see patients can cause any sense of responsibility to pass under their radar.
Just how bad is the problem?
In one study we did (ncbi.nlm.nih.gov/pubmed/22325482), we had people in
the OR masquerading as nurses in training. But they were actually there
to watch the anesthesia providers throughout the perioperative continuum. What they saw was more than 80% failed at hand hygiene.
One key is to make it as easy as possible for providers to wash their
hands, which may be needed a dozen or more times an hour, research
shows. Consider personal hand sanitizers — devices that can be
clipped onto scrubs and programmed to remind you to clean your
hands every so often. If you both remind people and provide an
ergonomically efficient way to do that, their rate of engaging in hand
hygiene increases. Amazingly, established research shows that the rate
of post-operative infection goes down.
But there's much more than hand hygiene to be concerned about. I
will ask anesthesia people: "Would you be willing to lick that laryngoscope for $20?" As ridiculous as that sounds, if you offer anyone on the
surgical side $20 to lick an instrument that just came out of a sterile
pack, they'd find that a very strange request, but they'd do it. But you'll
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | O C T O B E R 2013
