title: The dynamics of Enterococcus transmission from bacterial reservoirs commonly encountered by anesthesia providers.
abstract: BACKGROUND
  Enterococci, the second leading cause of health care-associated infections, have evolved from commensal and harmless organisms to multidrug-resistant bacteria associated with a significant increase in patient morbidity and mortality. Prevention of ongoing spread of this organism within and between hospitals is important. In this study, we characterized Enterococcus transmission dynamics for bacterial reservoirs commonly encountered by anesthesia providers during the routine administration of general anesthesia.
  
  
  METHODS
  Enterococcus isolates previously obtained from bacterial reservoirs frequently encountered by anesthesiologists (patient nasopharynx and axilla, anesthesia provider hands, and the adjustable pressure-limiting valve and agent dial of the anesthesia machine) at 3 major academic medical centers were identified as possible intraoperative bacterial transmission events by class of pathogen, temporal association, and phenotypic analysis (analytical profile indexing). They were then subjected to antibiotic disk diffusion sensitivity for transmission event confirmation. Isolates involved in confirmed transmission events were further analyzed to characterize the frequency, mode, origin, location of transmission events, and antibiotic susceptibility of transmitted pathogens.
  
  
  RESULTS
  Three hundred eighty-nine anesthesia reservoir isolates were previously identified by gross morphology and simple rapid tests as Enterococcus. The combination of further analytical profile indexing analysis and temporal association implicated 43% (166/389) of those isolates in possible intraoperative bacterial transmission events. Approximately, 30% (49/166) of possible transmission events were confirmed by additional antibiotic disk diffusion analysis. Two phenotypes, E5 and E7, explained 80% (39/49) of confirmed transmission events. For both phenotypes, provider hands were a common reservoir of origin proximal to the transmission event (96% [72/75] hand origin for E7 and 89% [50/56] hand origin for E5) and site of transmission (94% [16/17] hand transmission location for E7 and 86% [19/22] hand transmission location for E5).
  
  
  CONCLUSIONS
  Anesthesia provider hand contamination is a common proximal source and transmission location for Enterococcus transmission events in the anesthesia work area. Future work should evaluate the impact of intraoperative hand hygiene improvement strategies on the dynamics of intraoperative Enterococcus transmission.
authors.affiliation: From the *Department of Anesthesiology, Dartmouth-Hitchcock Medical Center; †The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; ‡Department of Anesthesiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa; §Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and ∥Department of Anesthesiology, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Randy W
authors.initials: RW
authors.lastname: Loftus
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Koff
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
authors.forename: Hetal M
authors.initials: HM
authors.lastname: Patel
authors.forename: Jens T
authors.initials: JT
authors.lastname: Jensen
authors.forename: Sundara
authors.initials: S
authors.lastname: Reddy
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Ruoff
authors.forename: Stephen O
authors.initials: SO
authors.lastname: Heard
authors.forename: Mark P
authors.initials: MP
authors.lastname: Yeager
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Dodds
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000758:Anesthesia / Q000009:adverse effects; D000776:Anesthesiology / Q000295:instrumentation / Q000379:methods; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D016521:Electrophoresis, Gel, Pulsed-Field; D013293:Enterococcus faecalis; D004866:Equipment Contamination / Q000517:prevention & control; D004867:Equipment Design; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D006225:Hand / Q000382:microbiology; D006235:Hand Disinfection; D008826:Microbial Sensitivity Tests; D009873:Operating Rooms; D010641:Phenotype; D011184:Postoperative Period; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents