Monday, July 21, 2014

Hand Hygiene and Video Observation in the Operating Room

In my institution, we are launching into an initiative for enhancing hand hygiene (HH) in the OR. Although the surgical hand scrub is an inviolate ritual in the surgical arena, hand hygiene in and around the OR is much less robust. The body of literature on HH in the OR is much smaller than in non-OR settings.  Here is an article on the use of video observation for HH monitoring that was recently published in the the American Journal of Infection Control.

The investigators used video observation in the OR to map patterns of anesthesia provider hand contact with anesthesia work environment (AWE) surfaces and to assess HH compliance. The World Health Organization criteria for HH was used as the HH standard. Serial bacterial cultures of high contact objects were performed to characterize bacterial transmission over time.

A low rate of HH compliance by anesthesia providers was observed (mean, 2.9%). Most importantly - an inverse correlation was observed between provider hand hygiene compliance during induction and emergence from anesthesia (3.2% and 4.1%, respectively) and the magnitude of AWE surface contamination (103 and 147 CFU, respectively). 

We need better mechanisms to both encourage HH and to make it feasible in an OR, particularly at the anesthesia work station. This will require education, promotion and feedback.

The benefits of improving HH in the OR is based on biological plausibility. The real impact of HH on surgical site infection remains unknown. This knowledge gap poses a problem for implementation and ''buy in'' from healthcare workers.

An uphill climb looms.

No comments:

Post a Comment