title: Hand hygiene and aseptic techniques during routine anesthetic care - observations in the operating room.
abstract: BACKGROUND
  More knowledge is needed about task intensity in relation to hand hygiene in the operating room during anesthetic care in order to choose effective improvement strategies. The aim of this study was to explore the indications and occurrence of hand hygiene opportunities and the adherence to hand hygiene guidelines during routine anesthetic care in the operating room.
  
  
  METHODS
  Structured observational data on hand hygiene during anesthetic care during 94 surgical procedures was collected using the World Health Organization's observational tool in a surgical department consisting of 16 operating rooms serving different surgical specialties such as orthopedic, gynecological, urological and general surgery.
  
  
  RESULTS
  A total of 2,393 opportunities for hand hygiene was recorded. The number of hand hygiene opportunities when measured during full-length surgeries was mean = 10.9/hour, SD 6.1 with an overall adherence of 8.1%. The corresponding numbers for the induction phase were, mean =77.5/h, SD 27.4 with an associated 3.1% adherence to hand hygiene guidelines. Lowest adherence was observed during the induction phase before an aseptic task (2.2%) and highest during full-length surgeries after body fluid exposure (15.9%).
  
  
  CONCLUSIONS
  There is compelling evidence for low adherence to hand hygiene guidelines in the operating room and thus an urgent need for effective improvement strategies. The conclusion of this study is that any such strategy should include education and practical training in terms of how to carry out hand hygiene and aseptic techniques and how to use gloves correctly. Moreover it appears to be essential to optimize the work processes in order to reduce the number of avoidable hand hygiene opportunities thereby enhancing the possibilities for adequate use of HH during anesthetic care.
authors: The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden.|Department of Anesthesia, Surgery and Intensive Care, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 85 Gothenburg, Sweden.
authors: Veronika
authors: V
authors: Megeus
authors: The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden.
authors: Kerstin
authors: K
authors: Nilsson
authors: Department of Orthopedics, Sahlgrenska Academy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.|The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
authors: Jon
authors: J
authors: Karlsson
authors: Department of Orthopedics, Sahlgrenska Academy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.|The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
authors: Bengt I
authors: BI
authors: Eriksson
authors: The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden.|The Swedish Institute for Health Science, Lund, Sweden.
authors: Annette Erichsen
authors: AE
authors: Andersson