Transmission of pathogenic bacterial organisms in the anesthesia work area.
BACKGROUND
The current prevalence of hospital-acquired infections and evolving amplification of bacterial resistance are major public health concerns. A heightened awareness of intraoperative transmission of potentially pathogenic bacterial organisms may lead to implementation of effective preventative measures.


METHODS
Sixty-one operative suites were randomly selected for analysis. Sterile intravenous stopcock sets and two sites on the anesthesia machine were decontaminated and cultured aseptically at baseline and at case completion. The primary outcome was the presence of a positive culture on the previously sterile patient stopcock set. Secondary outcomes were the number of colonies per surface area sampled on the anesthesia machine, species identification, and antibiotic susceptibility of isolated organisms.


RESULTS
Bacterial contamination of the anesthesia work area increased significantly at the case conclusion, with a mean difference of 115 colonies per surface area sampled (95% confidence interval [CI], 62-169; P < 0.001). Transmission of bacterial organisms, including vancomycin-resistant enterococcus, to intravenous stopcock sets occurred in 32% (95% CI, 20.6-44.9%) of cases. Highly contaminated work areas increased the odds of stopcock contamination by 4.7 (95% CI, 1.42-15.42; P = 0.011). Contaminated intravenous tubing was associated with a trend toward increased nosocomial infection rates (odds ratio, 3.08; 95% CI, 0.56-17.5; P = 0.11) and with an increase in mortality (95% CI odds ratio, 1.11-infinity; P = 0.0395).


CONCLUSIONS
Potentially pathogenic, multidrug-resistant bacterial organisms are transmitted during the practice of general anesthesia to both the anesthesia work area and intravenous stopcock sets. Implementation of infection control measures in this area may help to reduce both the evolving problem of increasing bacterial resistance and the development of life-threatening infectious complications.
Loftus
Randy W
RW
Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03756, USA. randy.loftus@hitchcock.org
Koff
Matthew D
MD
Burchman
Corey C
CC
Schwartzman
Joseph D
JD
Thorum
Valerie
V
Read
Megan E
ME
Wood
Tammara A
TA
Beach
Michael L
ML
D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects / Q000295:instrumentation*; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000295:instrumentation; D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000635:transmission*; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D016521:Electrophoresis, Gel, Pulsed-Field; D004866:Equipment Contamination / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009873:Operating Rooms; D010865:Pilot Projects; D018570:Risk Assessment