Anesthesiologists serve a pivotal function in the operating room. Through close contact with body fluids (e.g., blood, airway secretions, saliva, urine), anesthesia providers may contaminate the OR environment and spread pathogens. Dr. David J. Birnbach, Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida, and his colleagues examined patterns of transmission in a simulated OR environment.
In their study “The Use of a Novel Technology to Study Dynamics of Pathogen Transmission in the Operating Room“ published in an upcoming edition of Anesthesia & Analgesia, ten residents in anesthesiology (PGY 2-3) were tasked with performing an anesthesia induction on a human patient simulator. The residents were instructed to put on gloves prior to the start of the scenario but were given no further instructions with regard to glove use. Invisible fluorescent dye was placed on the lips and oral cavity of the simulator before each scenario. After the short scenario, the presence of this marker on potential sites within the simulated operating room was recorded. The spread of dye from the mannequin’s mouth to the OR environment demonstrates the anesthesiologist’s potential for spreading pathogens. The mannequin’s face and some items of the anesthesia equipment (e.g., laryngoscope, reservoir bag, anesthesia circuit, anesthesia machine surface) as well as the intravenous hub were contaminated in 100% of the simulations. Other areas frequently contaminated were the stethoscope (90%), medication syringes (90%), the computer keyboard (80%), and the door handle in the OR (60%). Contamination of the door handle occurred despite all participants having removed their gloves before leaving the room, thus indicating contamination of the ungloved hands via contaminated areas in the room.
These findings strongly suggest that we need to be conscious of our potential to spread pathogens within the OR. Although this was not a randomized and controlled trial, the importance of proper hand hygiene and compliance with ASA recommendations (removal of gloves immediately after intubation) is clearly evident.