When caring for patients who are or may be actively infectious, extra precautions are necessary in order to protect health care providers and other patients while providing needed interventions. Standard precautions used for all patient care are based on a risk assessment to achieve this goal. These precautions span hand hygiene, the use of personal protective equipment, respiratory hygiene, patient placement, equipment disinfection, and safe injection practices, among others 1. Transmission-based precautions are adhered to, on top of standard precautions, in cases of known or suspected infections. In the context of surgery and anesthesia, as well as some other situations, precautions for patients with infectious disease are especially important due to the higher risk of exposure.
Anesthesia providers practice in a nonsterile environment within the operating room and frequently come into contact with areas that can transmit infection in many diseases, such as the nares, axilla, and pharynx 2. As a result, anesthesia providers have strict protocols to prevent health care–associated infections, including surgical site infections.
Anti-infection practices have been widely implemented across operating rooms as precautions against infectious disease transmission during surgery. Strategies include air purification, decontamination, and hand hygiene.
Air purification
Airborne infections that may infect vulnerable hosts are transmitted via droplets or droplet nuclei. It is vital to have in proper systems to remove contaminated air in order to minimize the risk of airborne pathogens being transmitted 2.
Skin and other bacterial reservoir decontamination
The most significant and frequent methods of hospital infection transmission are through direct or indirect transmission. Procedures such as the decontamination of preoperative patient skin and other bacterial reservoirs and hand hygiene by anesthesia and surgical providers reduce the chances of contamination of the work area and intravenous access ports.
Hand hygiene
Hand hygiene is a well-known and effective solution to prevent bacterial transmission within and across patients. It is considered the most essential and cost-effective individual intervention in the prevention of health care–associated infections in children, adults, and health care providers. Compliance with the current “5 moments” World Health Organization guidelines may heavily reduce provider hand and workspace contamination rates 3. Research has found that, without guidance, anesthesiologists perform hand hygiene less than once per hour; with reminders, the rate of hand hygiene is more frequent. As a result, improved hand hygiene reduces contamination of the work area and intravenous access ports from 32% to 8%, which in turn significantly reduces hospital acquired infections 4.
Surgical patients, whether they already have an infectious disease or not, are placed under significant physiological stress due to the procedure and may be more susceptible to infections postoperatively. Surgical antimicrobial prophylaxis is an essential tool used to reduce the chance of postoperative infections. With the anesthesia team playing a pivotal role in ensuring the proper timing of drug administration 5, the aim of the perioperative administration of antibiotics is to ensure, in patient plasma and tissue, drug concentrations which exceed the minimum required concentration to inhibit an infection. This reduces the microbial load of the intraoperative contamination. However, it does not cover all pathogens since such an approach would result in the selection of drug-resistant bacteria.
Precautionary protocols, although effective, require continuous feedback and revision 2. –-The judgment of the medical professional is also important, however, and sound clinical reasoning must be tailored to individual contexts.
Institutional administrative measures aimed at developing, implementing, and monitoring accident prevention policies and procedures are key to reducing pathogen transmission in health care centers. A deep understanding of the characteristics of transmission and appropriate precautions provides the practicing anesthesiologist with the methods required to protect patients and themselves from infectious disease during surgery and in other contexts.
References
1. Standard Precautions for All Patient Care | Basics | Infection Control | CDC. Available at: https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html. (Accessed: 24th February 2023)
2. Jaichenco, A. L. & Lima, L. C. Infectious Disease Considerations for the Operating Room. A Pract. Anesth. Infants Child. 1146 (2019). doi:10.1016/B978-0-323-42974-0.00050-1
3. World Hand Hygiene Day. Available at: https://www.who.int/campaigns/world-hand-hygiene-day. (Accessed: 24th February 2023)
4. Koff, M. D. et al. Reduction in intraoperative bacterial contamination of peripheral intravenous tubing through the use of a novel device. Anesthesiology (2009). doi:10.1097/ALN.0b013e3181a06ec3
5. Jarvis, W. R. Benchmarking for Prevention: The Centers for Disease Control and Prevention’s National Nosocomial Infections Surveillance (NNIS) System Experience. in Infection, Supplement (2003).