SHEA Makes Recommendations for Infection Control in Anesthesiology

Silvia Munoz-Price, MD, PhD

The Society for Healthcare Epidemiology of America (SHEA) has published new guidance on preventing infections in the operating room, specifically in the anesthesia work area.

Some of the key recommendations touch on: when hand hygiene should be performed, precautions during airway management, environmental disinfection precautions, and IV drug injection recommendations.

The recommendations were written by a panel of representatives from SHEA, the American Society of Anesthesiologists (ASA), the Anesthesia Patient Safety Foundation (APSF), and the American Association of Nurse Anesthetists (AANA).

"Even though the demands on anesthesia providers make infection prevention best practices more challenging, there are opportunities for improvement," said Silvia Munoz-Price, MD, PhD, lead author of the guidance and professor of medicine at Froedtert & Medical College of Wisconsin. "We describe how the anesthesiology team and hospital leaders can optimize infection prevention in operating room anesthesia, and we give suggestions for the future, including the need for better equipment design."

The guidance recommends that health care providers perform hand hygiene at a minimum of 5 points: before aseptic tasks, after removing gloves, when hands are soiled or contaminated, before touching the contents of the anesthesia cart, and when entering and exiting the operating room. Additionally, strategically-placed alcohol-based hand sanitizer dispensers are recommended at the entrances to operating rooms and near the anesthesia providers inside those rooms.

During airway management, the guidance recommends that providers wear double gloves and remove the outer layer immediately after airway manipulation. The rationale is that providers don’t have time to perform hand hygiene during this procedure, but that removing the outer gloves reduces the risk of contamination from upper-airway secretions.

On the environmental disinfection topic, the report highlights the need for high-level disinfection on any reusable laryngoscope handles and blades. Alternatively, the report recommends introducing single-use laryngoscopes. Furthermore, where there is a risk for the presence of C difficile, they recommend autoclaving laryngoscope handles.

The guidance authors highlight ways to reduce the risk of contamination during the use of IV drugs. They recommend the use of single-dose vials and flushes but note that if multiple-dose medication vials are necessary, they should be used for a single patient only. Additionally, rubber stoppers and necks of medication vials should be wiped with 70% alcohol before vial access.

The guidance is clear about the challenge of implementing disinfection practices in the challenging environment of the operating room. The authors call on hospital facility administrators to join with anesthesia departments to implement these recommendations.

"These guidelines address the evidence base for infection prevention while taking into account the realities of the operating room and the complexities involved in providing anesthesia services," said ASA President Linda Mason, MD, FASA.

The guidance authors also point to future improvements, including the need for a redesign of the anesthesia machine. Primarily they call for investment in more research “to better understand the infection prevention and control problems posed by the anesthesia work station and to develop design improvements that reduce the risk of infection.”

The recommendation, “SHEA Expert Guidance: Infection prevention in the operating room anesthesia work area,” was published in SHEA's journal, Infection Control & Hospital Epidemiology.