Anesthesia Providers cannot wash their hands

in the Operating Room

with soap and water.

There are no sinks in the operating room because of associated pathogens.

Cannot leave anesthetized patients to go wash hands.

Jeanes et al. 2018

“Anaesthetics is not comparable to work undertaken by staff on most general hospital wards. It was often not feasible or desirable to stop to wash or gel hands during critical stages of the anaesthetic process; such as after administration of the initial intravenous anaesthetic and before maintaining the airway. The speed and skill of delivering the anaesthetic and caring for the anesthetised patient is crucial to the patient outcome and disruption of this safe process could be detrimental.” (p. 120)

HH-133 Jeanes A, Dick J, Coen P, Drey N, Gould DJ. Hand hygiene compliance monitoring in anaesthetics: Feasibility and validity. J Infect Prev. 2018;19(3):116-122. doi:10.1177/1757177418755306

Rowlands et al. 2014

“Compliance with current (WHO) HH recommendations by anesthesia providers is not feasible. . . HH compliance was lowest during the first and last twenty minute time epochs when the average number of opportunities were 99 and 39 respectively . . . as noted, these two time epochs—case start and case end—also had the highest bacterial contamination, determined by average colony forming units of the twenty most frequently touched objects, compared with mean colony forming unit counts during the remainder of surgery. . . Complete compliance with HH practice as recommended by World Health Organization guidelines would have consumed more than the sixty minutes available in each hour of anesthesia time, a fact that identifies a need to create more practical—but still effective—methods of controlling bacterial transmission in the anesthesia work environment.” (p. 698, 700-701)

HH-95 Rowlands J, Yeager MP, Beach M, Patel HM, Huysman BC, Loftus RW. Video observation to map hand contact and bacterial transmission in operating rooms. Am J Infect Control. 2014;42(7):698-701. doi:10.1016/j.ajic.2014.02.021

Koff et al. 2016

“To achieve 70% compliance (with WHO 5 moments), . . . (anesthesia) providers would have to wash their hands at least every thirty seconds. Thus, achieving a seventy percent opportunity-based hand hygiene compliance rate in the operating room with this system does not seem feasible.” (p. 894)

HH-124 Koff MD, Brown JR, Marshall EJ, et al. Frequency of Hand Decontamination of Intraoperative Providers and Reduction of Postoperative Healthcare-Associated Infections: A Randomized Clinical Trial of a Novel Hand Hygiene System. Infect Control Hosp Epidemiol. 2016;37(8):888-895. doi:10.1017/ice.2016.106

Biddle et al. 2012

“Performing adequate HH in such a setting can prove daunting if not impossible given the intensity and nature of the provider-to-patient interactions. . .Whereas criticism might be directed that this study holds anesthesia providers to an impossibly high standard, it might also be viewed as a further opportunity to generate a much needed dialogue on the issue and to promote novel educational and interventional strategies to improve practice. Given the demands of anesthesia care and the high rate of HH opportunities, aggressive strategies for achieving improved rates of HH should be pursued.” (p.758-759)

HH-8 Biddle C, Shah J. Quantification of anesthesia providers' hand hygiene in a busy metropolitan operating room: what would Semmelweis think?. Am J Infect Control. 2012;40(8):756-759. doi:10.1016/j.ajic.2011.10.008

Munoz-Price et al. 2014

“The World Health Organization’s ‘Five Moments for Hand Hygiene’ are relatively easy to follow outside the OR; nevertheless, when we tried to extrapolate them to anesthesia providers in the ORs, we discovered that these guidelines were not logistically feasible, especially during induction. Thus, hand hygiene recommendations should be tailored for anesthesia providers in the OR and may involve other solutions, including wearing double gloves during induction. . . Ideally, these guidelines should have a reasonable expectation for hand hygiene frequency during both induction and maintenance without interfering with anesthesiologists’ workflow or impacting patient safety.” (HH-128 p.1058)

HH-128 Munoz-Price LS, Riley B, Banks S, et al. Frequency of interactions and hand disinfections among anesthesiologists while providing anesthesia care in the operating room: induction versus maintenance. Infect Control Hosp Epidemiol. 2014;35(8):1056-1059. doi:10.1086/677154

Haac et al. 2017

“Previous studies evaluating compliance with WHO guidelines have shown that HH opportunities are frequent, sometimes over 44 HH opportunities per patient per hour, and are associated with low compliance suggesting that strict adherence to the guidelines may not be feasible. In time sensitive conditions, like emergent care, time is of the essence. It is unclear if the time used for HH would be better spent in direct patient care which could be life saving and whether HH in these particular settings actually improves outcomes . . . Despite the general consensus that HH is an important tool in infection prevention, widespread and mandatory adoption of the WHO Five Moments has limitations including a lack of evidence to support the practice and practicality (or impracticality) of its implementation, especially in emergency, critical care and surgical settings. Clinical practice as seen in our study suggests that strict adherence to the WHO ‘My Five Moments’ of HH may be infeasible in the setting of active resuscitation.” (page 2 and 8)

HH-50 Haac B, Rock C, Harris AD, et al. Hand Hygiene Compliance in the Setting of Trauma Resuscitation. Injury. 2017;48(1):165-170. doi:10.1016/j.injury.2016.08.004. 

Megeus et al. 2015

“Even if there exists an extensive body of knowledge on hand hygiene in different healthcare setting these findings may not be applicable to the OR setting.” (p.6)

HH-24 Megeus V, Nilsson K, Karlsson J, Eriksson BI, Andersson AE. Hand hygiene and aseptic techniques during routine anesthetic care - observations in the operating room. Antimicrob Resist Infect Control. 2015;4(1):5. Published 2015 Feb 6. doi:10.1186/s13756-015-0042-y