1. Easing the Pain: Infection Control and Anesthesia Susan A. Dolan, RN, MS, CIC Children’s Hospital Colorado Robin Stackhouse, MD University of California, San Francisco APIC Annual Education Conference June 7-9 2014 Anaheim, CA

2. Objective Identify 3 areas where there is a gap between Anesthesia’s daily practice and infection prevention & control Utilize evidence based information to address gaps in Anesthesia IP&C Initiate the use of an IP&C assessment tool with Anesthesia team at your facility

3. Anesthesia OR Work Environment South Bay

5. Hand Hygiene-Expectations Prior to first interacting with patient Prior to donning sterile gloves After any invasive procedure After manipulation of the airway (intubation, suctioning) After touching the patient for surgical positioning After glove removal After retrieving a soiled or dropped item from OR floor Biddle C. Shah J. AJIC 2012:40(8):756-9

6. Results: 8,000 HH opportunities were observed Aggregate failure rate was 82% with a range of 64% to 93% by provider group Conclusions: HH was very poor among anesthesia providers. This intrinsic HH failure rate creates a great opportunity for horizontal and vertical vectors for nosocomial infection Biddle C. Shah J. AJIC 2012:40(8):756-9

7. Contact of Surfaces by Anesthesiologist Anesthesia Per hour Munoz-Prize, Infect Control Hosp Epidemiology 2014

8. Hand hygiene by Anesthesiologist Anesthesia Per hour Munoz-Prize, Infect Control Hosp Epidemiology 2014

9. Major categories of HH failure Moving between patients during pre-op Before, during and after placing nerve blocks After any invasive procedure Soiled gloves left on after airway manipulation After touching the patient for surgical positioning After picking up item from floor (pen, tape) and using it. Biddle C. Shah J. AJIC 2012:40(8):756-9

10. Work flow issues: Intubation….. Adjusting gases and vent settings Double glove? Remove outer gloves and not perform HH Wear gloves for identified “dirty environment”?

11. Where to go from here?

12. Collaborative Approach The Inside View: The Inside View: Anesthesiology team Anesthesiology team Surgical team Surgical team The Outside View: The Outside View: Infection Prevention team Infection Prevention team

13. Share Anesthesia IP&C Assessment Tool P&P Hand Hygiene / Glove use PPE / Attire Environment (clean vs. dirty) OR Attire Safe injection practices and medications IV supplies and therapy Respiratory care procedures / equipment Disinfection Exposure Management

14. Recommendations / Suggestions 1. Clearly define “clean” and “dirty” areas during a case: “Clean”: medication prep area / IV access / (intubation) “Dirty”: keyboards / anesthesia machine / trash containers/ floor. 2. Perform hand hygiene when changing from “dirty” to “clean”. 2. Have alcohol gel dispensers accessible 3. Perform HH as you enter and exit the OR 4. Perform HH prior to donning sterile gloves 6. Before accessing clean supplies, med prep or administration 7. Double glove during intubation? remove the outer set immediately after intubation (1 study found contamination of intraoperative environment was dramatically reduced). see abstract online in Anesthesia & Analgesia May 15

15. Thank you!