You’ve heard it since you were too young to remember: “Wash your hands!” Despite that, many anesthesia providers practice poor habits in this area. Although most anesthesiologists on direct questioning will “know” the benefits of good hand hygiene, their habits may leave something to be desired. We must remember that hand hygiene (handwashing and glove use) benefits not only you but also your patients.
Although the absolute indications for ideal handwashing practice is not known (because of the lack of controlled studies), the Centers for Disease Control and Prevention (CDC) state that health care workers (HCWs) should “decontaminate hands before having direct contact with patients,” after “contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings,” and even after “contact with a patient’s intact skin” (Table 62.1). These recommendations are based on their findings that “Handwashing is the single most important procedure for preventing nosocomial infections” (Boyce and Pittet, 2002).
The American Society of Anesthesiologists (ASA) has also published guidelines for hand hygiene using the above findings as justification. Stating that “strict adherence to handwashing and aseptic technique remains the cornerstone of prevention of catheter-related infections,” the ASA recommends that hands be washed before and after any patient contact, as indicated in Table 62.2. Their statement details the use of both hand cleansing and glove use. For this discussion, both will be included in the term “hand hygiene.”
As obvious as the above standards may seem, anesthesiologists have repeatedly been shown to be among the worst of physicians for adherence to hand hygiene standards. Pittet et al. (2004) demonstrated that anesthesiologists showed proper hand hygiene only 23% of the time. In a survey of anesthesiologists in the United Kingdom, El Mikatti et al. stated that only 36.4% washed their hands between cases. Studies show that anesthesiologist hand hygiene rates increase, however, when they perceive an infectious threat. Tait and Tuttle (1995) showed that when treating patients thought to be carrying HIV or HBV, 95% of HCWs washed their hands, versus only 58% of HCWs for the exact same patients when knowledge of HIV or HBV status was not known. This suggests the HCWs understand the importance of hand hygiene in preventing the transmission of disease but fail to appreciate its importance in routine contact. Although it is noted that these studies may be somewhat dated, clear evidence that hand hygiene has improved within anesthesiology is not available.
TABLE 62.1 CDC RECOMMENDATIONS FOR ACTIVITIES THAT REQUIRE HANDWASHING
1)
Decontaminate hands before having direct contact with patients.
2)
Decontaminate hands before donning sterile gloves when inserting a central intravascular catheter.
3)
Decontaminate hands before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure.
4)
Decontaminate hands after contact with a patient’s intact skin (e.g., when taking a pulse or blood pressure, or lifting a patient).
5)
Decontaminate hands after contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings even if hands are not visibly soiled.
6)
Decontaminate hands if moving from a contaminated-body site to a clean-body site during patient care.
7)
Decontaminate hands after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient.
8)
Decontaminate hands after removing gloves.
9)
Before eating and after using a restroom, wash hands with a nonantimicrobial soap and water or with an antimicrobial soap and water.
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Never Neglect the Basics of Airway Management
