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Education  |   March 2012
A Proposal to Minimize Work Area Contamination during Induction
Author Affiliations & Notes
  • Harriet W. Hopf, M.D.
    *
  • *Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah.
Article Information
Education / Airway Management / Education / CPD / Infectious Disease / Patient Safety
Education   |   March 2012
A Proposal to Minimize Work Area Contamination during Induction
Anesthesiology 3 2012, Vol.116, 712. doi:10.1097/ALN.0b013e318231fc3e
Anesthesiology 3 2012, Vol.116, 712. doi:10.1097/ALN.0b013e318231fc3e
CONTAMINATION of the anesthesia work area is common during intubation, when oral flora may be transferred by hands and equipment, and is associated with increased healthcare-associated infections.1,2 Frequent hand hygiene by anesthesia providers reduces healthcare-associated infections.1 Patient safety requires not turning away during intubation. Immediate glove removal and double gloving have been advocated to reduce contamination.3 We describe a comprehensive approach that may reduce workspace contamination without distracting from patient safety during a critical time.
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Place clean intubating tools on a clean workspace. Repeat hand hygiene after patient contact (applying monitors) but before donning two pairs of gloves for induction. Place a clean towel on the patient's chest or at a site easily reached. At the start of intubation, place the mask on the towel. As shown in the photo of an awake medical student model, as soon as the tube is in place, remove the outer gloves and place them on the towel. Then inflate the cuff, attach the circuit, and secure the tube. Move the towel and supplies to a workspace area designated for contaminated items. Perform hand hygiene and wipe down the work area.
We have not measured workspace contamination to show that this technique reduces it. However, we think this is a reasonable approach to maintaining focus on the patient and on infection control at a clinically critical time when there is a high potential for workspace contamination. Additional research to determine whether and to what degree this approach reduces workspace contamination is warranted.
The authors appreciate the assistance of Greg Wallace, M.D. (Resident, Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah), in obtaining the photograph.
References
Koff MD, Loftus RW, Burchman CC, Schwartzman JD, Read ME, Henry ES, Beach ML: Reduction in intraoperative bacterial contamination of peripheral intravenous tubing through the use of a novel device. ANESTHESIOLOGY 2009; 110:978–85
Loftus RW, Muffly MK, Brown JR, Beach ML, Koff MD, Corwin HL, Surgenor SD, Kirkland KB, Yeager MP: Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission. Anesth Analg 2011; 112:98–105
Perry SM, Monaghan WP: The prevalence of visible and/or occult blood on anesthesia and monitoring equipment. AANA J 2001; 69:44–8
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