title: Video observation to map hand contact and bacterial transmission in operating rooms.
abstract: BACKGROUND
  Hand hygiene (HH) is considered a primary intervention to avoid transmission of bacteria in health care settings and to prevent health care-associated infections. Despite efforts to decrease the incidence of health care-associated infections by improving HH, HH compliance rates vary widely depending on the hospital environment.
  
  
  METHODS
  We used intraoperative video observation to map temporal patterns of anesthesia provider hand contact with anesthesia work environment (AWE) surfaces and to assess HH compliance. Serial bacterial cultures of high contact objects were subsequently used to characterize bacterial transmission over time.
  
  
  RESULTS
  Using World Health Organization criteria, we found a large number of HH opportunities and a low rate of HH compliance by anesthesia providers (mean, 2.9%). We observed an inverse correlation between provider hand hygiene compliance during induction and emergence from anesthesia (3.2% and 4.1%, respectively) and the magnitude of AWE surface contamination (103 and 147 CFU, respectively) at these time points. We found no correlation between frequency of hand contact with the AWE and bacterial contamination.
  
  
  CONCLUSIONS
  Compliance with current HH recommendations by anesthesia providers is not feasible. However, there does appear to be a correlation between HH compliance rates and bacterial contamination of the AWE, an observation that should stimulate further work to design new methods for control of bacterial transmission in operating rooms.
authors: Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: John
authors: J
authors: Rowlands
authors: Departments of Anesthesiology and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: mark.p.yeager@hitchcock.org.
authors: Mark P
authors: MP
authors: Yeager
authors: Departments of Anesthesiology and Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Michael
authors: M
authors: Beach
authors: Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Hetal M
authors: HM
authors: Patel
authors: Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Bridget C
authors: BC
authors: Huysman
authors: Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Randy W
authors: RW
authors: Loftus
mesh_terms: D000758:Anesthesia / Q000379:methods*; D001419:Bacteria / Q000302:isolation & purification; D004864:Equipment and Supplies / Q000382:microbiology; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D009873:Operating Rooms; D014741:Video Recording
keywords: Equipment contamination; Hand hygiene; Health care-associated infection