title: Quantifying the rambunctious journey of the anesthesia provider's hands during simulated, routine care.
abstract: The role of anesthesia providers in dispersing potentially pathogenic material from one patient to another during intraoperative care needs further study. In this study we aimed (1) to quantify the dispersion of a surrogate pathogen from a simulated patient's mouth to the anesthesia workstation during routine anesthetic induction, (2) to test the hypothesis that there would be fewer contamination sites by providers who used a double-gloving technique, and (3) to examine the effectiveness of between-case anesthesia apparatus disinfection.
  
  
  
  Twenty subjects were randomized to a single pair of gloves group (group 1) or a double-gloved group (group 2) and completed a simulated general anesthesia induction, completing a standardized set of interventions. Dispersion of a surrogate pathogen dye placed in the oral cavity of the simulated patient was tracked by a blinded observer and photography. Standard cleaning of the workstation was performed, and residual dye was quantified. Group performance was plotted using regression analysis and rate of contamination compared using parametric statistics.
  
  
  
  Group 1 contaminated an average of 16.0 (SEM = 0.89) sites compared with group 2, who contaminated an average of 7.6 (SEM = 0.85). The cart drawers, gas flow dials, medication vials, and ventilator controls were significantly contaminated by group 1, but not by group 2 (P < .05 in all cases). There were similar rates of contamination in both groups for the airway equipment, breathing system, intravenous access ports, and the roll of tape used to secure the endotracheal tube. Once the airway management phase of the induction ended, new site contamination continued at a high rate in group 1 but not group 2.
  
  
  
  A double-gloving technique was associated with less spread of an oral inoculum to the workstation but was not uniformly protective. Between-case cleaning was ineffective in removing the contaminant, indicating that biologic material from one patient may be present when subsequent patients are cared for. This suggests risks for the current patient (eg, skin or oral site transfer to an intravenous site) and also may place future patients at risk. Importantly, using models that simulate actual clinical events can inform clinical practice and decipher challenging areas of ergonomics.
authors.affiliation: Departments of Nurse Anesthesia & Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA. Electronic address: cjbiddle@vcu.edu.
authors.forename: Chuck
authors.initials: C
authors.lastname: Biddle
authors.affiliation: Departments of Nurse Anesthesia & Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Robinson
authors.affiliation: Departments of Nurse Anesthesia & Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pike
authors.affiliation: Center for Research in Human Simulation, Virginia Commonwealth University Medical Center, Richmond, VA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kammerman
authors.affiliation: Department of Nurse Anesthesia, Virginia Commonwealth University Medical Center, Richmond, VA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Gay
authors.affiliation: Virginia Institute for Behavioral Genetics, Virginia Commonwealth University, Richmond, VA.
authors.forename: Brad
authors.initials: B
authors.lastname: Verhulst
mesh_terms: D000758:Anesthesia / Q000379:methods*; D000072080:Anesthesiologists; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004389:Durable Medical Equipment / Q000382:microbiology*; D006225:Hand / Q000382:microbiology*; D006801:Humans; D008962:Models, Theoretical
keywords: Anesthesia workstation; Contamination; Handwashing; Medical simulation