Anesthesia in patients with infectious disease caused by multi-drug resistant bacteria.
OBJECTIVE
Up to 50% of specific bacterial strains in healthcare admission facilities are multi-drug resistant organisms (MDROs). Involvement of anesthesiologists in management of patients carrying/at risk of carrying MDROs may decrease transmission in the Operating Room (OR).


RESULTS
Anesthesiologists, their work area and tools have all been implicated in MDRO outbreaks. Causes include contamination of external ventilation circuits and noncontribution of filters to prevention, inappropriate decontamination procedures for nondisposable equipment (e.g. laryngoscopes, bronchoscopes and stethoscopes) and the anesthesia workplace (e.g. external surfaces of cart and anesthesia machine, telephones and computer keyboards) during OR cleaning and lack of training in sterile drug management.


CONCLUSIONS
Discussions regarding the management of potential MDRO carriers must include anesthesia providers to optimize infection control interventions as well as the anesthesia method, the location of surgery and recovery and the details of patient transport. Anesthesia staff must learn to identify patients at risk for MDRO infection. Antibiotic prophylaxis, although not evidence based, should adhere to known best practices. Adjuvant therapies (e.g. intranasal Mupirocin and bathing with antiseptics) should be considered. Addition of nonmanual OR cleaning methods such as ultraviolet irradiation or gaseous decontamination is encouraged. Anesthesiologists must undergo formal training in sterile drug preparation and administration.
aThe Surgical Intensive Care Unit bThe Infectious Disease Unit, Shaare Zedek Medical Center and the Hebrew University, Faculty of Medicine, Jerusalem, Israel.
Sharon
S
Einav
Yonit
Y
Wiener-Well
D000758:Anesthesia / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D000072080:Anesthesiologists / Q000592:standards; D000776:Anesthesiology / Q000295:instrumentation* / Q000592:standards; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000592:standards; D003141:Communicable Diseases / Q000188:drug therapy* / Q000382:microbiology; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004202:Disinfectants / Q000627:therapeutic use; D004203:Disinfection / Q000379:methods / Q000592:standards; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D009873:Operating Rooms / Q000592:standards; D019990:Perioperative Care / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D059039:Standard of Care; D013242:Sterilization / Q000379:methods / Q000592:standards; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000592:standards; D014187:Transportation of Patients / Q000379:methods / Q000592:standards
D000900:Anti-Bacterial Agents; D004202:Disinfectants