Quantifying the rambunctious journey of the anesthesia provider’s hands during simulated, routine care CJ Biddle CRNA, PhD, Kathryn Robinson, BSN, Benjamin Pike, BSN Michael Kammerman, AS, Beverly Gay, RN, MSN, Brad Verhulst, PhD Virginia Commonwealth University Medical Center, Richmond, VA

1)quantify the dispersion of surrogate pathogen from the mouth throughout the anesthesia workstation during routine general anesthetic induction 2) test the hypothesis that there would be fewer contamination sites caused by providers who used a double- gloving technique 3) examine the effectiveness of the between-case anesthesia apparatus disinfection protocol Study aims:

Routine interventions performed by all providers Preoxygenation Administering IV midazolam, fentanyl, lidocaine, propofol, succinylcholine Adjusting the flow control of the intravenous fluids Controlling ventilation by mask with an oral airway in situ Performing laryngoscopy and placing an endotracheal tube Connecting the circle system to breathing tube and inflating pilot balloon Auscultating breath sounds Securing the endotracheal tube with tape Adjusting the mechanical ventilator settings to achieve normocarbia Administering a volatile anesthetic agent via the anesthetic vaporizer Readjusting the flow control of the intravenous fluids Placing an orogastric tube and an esophageal temperature probe Administering an intravenous antibiotic Administering an intravenous antiemetic

The clear, odorless dye that we used (DAZO) UV Light Source (Wood’s Lamp)

The high fidelity Human Simulator where the DAZO was applied to the tip of the tongue)

Subjects were randomized to: Group 1 (single pair) Group 2 (double gloving) +

Dye fluoresces under UV light. Example contamination sites (clockwise): drug syringe, ventilator controls, vaporizer control, breathing circuit, IV flow control

Dye fluoresces under UV light. Example contamination sites (clockwise): reservoir circuit breathing bag, drug injection ports, drawers on supply cart

Demonstration of group divergence when airway management (successful intubation) is completed. When outer gloves are removed (double gloving group) subsequent site contamination decreases

The effectiveness of cleaning the equipment and anesthesia workstation was also evaluated using the DAZO dye technique

TAKE-AWAY OUTCOMES OF STUDY: DOUBLE GLOVING ASSOCIATED LESS SPREAD OF SURROGATE PATHOGEN DOUBLE GLOVING WAS NOT UNIVERSALLY PROTECTIVE IV STOPCOCK CONTAMINATED IN 1/3 OF THE CASES OVERALL LITTLE DIFFERENCE IN STOPCOCK CONTAMINATION BY GLOVE GROUP ROUTINE BETWEEN CASE CLEANING VERY INEFFECTIVE ONLY STUDIED FIRST ~ 10 MINUTES OF A CASE EDUCATION, TRAINING AND EQUIPMENT REDESIGN DISCUSSED THE VALUE OF SIMULATION IN ADVANCING OUR UNDERSTANDING WAS DEMONSTRATED