Is Hand Contamination of Anesthesiologists Really an “Important” Risk Factor for Intraoperative Bacterial Transmission?

Abstract

To the Editor Although it is encouraging to read of the awareness of the potential impact of anesthesiologists on disease transmission in the operating room (OR) through a prospective study1 and expert opinion,2,3 with emphasis on more diligent handwashing, the data do not support the conclusion by Loftus et al.1 that “bacterial organisms on hands of providers explained a fairly large proportion of overall environmental and patient IV stopcock set contamination.” More specifically, anesthesia providers were identified as the origin in 12% of environmental contamination cases (10% of total cases) and 5.5% of the IV stopcock cases. Neither of these are “a fairly large proportion.” More pressing is the origin of 88% of environmental and 94.5% of stopcock contaminants. These could be innumerable personnel in the OR, preoperative area, patient escort, or even the valet parking attendant. Anesthesiologist transmission to the stopcock is no more likely than ineffective decontamination between cases (7% for environment, 5% for stopcock). How does this documented transmission rate compare to the daily OR activity with 6-armed robots, lengthy laparoscopic instruments or orthopedic nailing apparatus, or redraping of the radiograph machine for multiple lateral views? One editorial opines, “If we have reached a plateau in attempts to lower the SSI rate because we have gone as far as we reasonably can with surgical antisepsis, then remaining targets are the patient and anesthesia provider.”2 Clearly, we have not reached any plateau of surgical antisepsis given daily OR logistics. How does the anesthesia provider become a primary focus when the anesthesiologist is associated with contamination in 1/12 (environmental) and 1/20 (stopcock) cases? As leaders in patient safety, identification of any ill effect that anesthesiologists could have on patients is necessary. However, an individual's “microbiome” does not equal infection. Evidence cannot be overinterpreted, as we run the risk of being “slimed” in the more customary fashion: if a surgical patient has complications, it must have been due to the coincidental anesthetic. Evan G. Pivalizza, MD Sam D. Gumbert, MD Douglas Maposa, MD Department of Anesthesiology University of Texas Medical School–Houston Houston, Texas [email protected]