Contamination of equipment and surfaces in the operating room anesthesia workspace: a cross-sectional study
Keywords:
Infection control, Anesthesia, general, Equipment contamination, Patient safety, Colonization, Microorganisms, Mechanical ventilation, Cleaning and disinfection, Breathing circuitAbstract
BACKGROUND: Contamination of the breathing circuit and medication preparation surface of an anesthesia machine can increase the risk of cross-infection.
OBJECTIVE: To evaluate the contamination of the anesthetic medication preparation surface, respiratory circuits, and devices used in general anesthesia with assisted mechanical ventilation.
DESIGN AND SETTING: Cross-sectional, quantitative study conducted at the surgical center of a philanthropic hospital, of medium complexity located in the municipality of Três Lagoas, in the eastern region of the State of Mato Grosso do Sul.
METHODS: Eighty-two microbiological samples were collected from the breathing circuits. After repeating the samples in different culture media, 328 analyses were performed.
RESULTS: A higher occurrence of E. coli, Enterobacter spp., Pseudomonas spp., Staphylococcus aureus, and Streptococcus pneumoniae (P < 0.001) were observed. Variations were observed depending on the culture medium and sample collection site.
CONCLUSION: The study findings underscore the inadequate disinfection of the inspiratory and expiratory branches, highlighting the importance of stringent cleaning and disinfection of high-touch surfaces.
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Jelacic S, Bowdle A. Contamination in the operating room environment: Patients, providers, surfaces, and air. In: Bearman G, Morgan DJ, Murthy RK, Hota S, editors. Infection Prevention. Cham: Springer; 2022. http:// dx.doi.org/10.1007/978-3-030-98427-4_5.
Dexter F, Loftus RW. Retrospective cohort study of anaesthesia machines shows low bacterial contamination can be achieved with surface disinfection. Br J Anaesth. 2023;131(4):e109-e111. PMID: 37563035; https://doi.org/10.1016/j.bja.2023.07.016.
Yezli S, Barbut F, Otter JA. Surface contamination in operating rooms: a risk for transmission of pathogens? Surg Infect (Larchmt). 2014 Dec;15(6):694-9. PMID: 25317716; https://doi.org/10.1089/sur.2014.011.
Jaichenco AL, Lima LC. Infectious disease considerations for the operating room. In: Coté CJ, Lerman J, Anderson, BJ. A practice of anesthesia for infants and children. 6 ed. Philadelphia: Elsevier; 2019. p. 1146-60.e4. https://doi.org/10.1016/B978-0-323-42974-0.00050-1.
Sharma A, Fernandez PG, Rowlands JP, Koff MD, Loftus RW. Perioperative infection transmission: the role of the anesthesia provider in infection control and healthcare-associated infections. Curr Anesthesiol Rep. 2020;10(3):233-41. PMID: 32837343; https://doi.org/10.1007/s40140020-00403-8.
Oliveira LP, Lucato ALS, Fernandes DR, et al. Use of technology for self-care in surgical wound infection surveillance: integrative review.
Rev Bras Enferm. 2022;75(3):e20210208. PMID: 35137885; https://doi. org/10.1590/0034-7167-2021-0208.
Jaichenco AL, Lima LC. Infectious disease considerations for the operating room. In: Coté CJ, Lerman J, Anderson, BJ. A practice of anesthesia for infants and children. 6 ed. Philadelphia: Elsevier; 2019. p. 1146-60.e4. https://doi.org/10.1016/B978-0-323-42974-0.00050-1.
Tash RME, Wegdan AA, Amer FA, Bassyouni RHA, Botros JM. Pattern of anaesthetic equipment contamination and infection prevention in anaesthesia practice at university hospitals. Indian J Anaesth.
;62(10):786-792. PMID: 30443062; https://doi.org/10.4103/ija. IJA_41_18.
Branco A, Lourençone EMS, Monteiro AB, et al. Education to prevent ventilator-associated pneumonia in intensive care unit. Rev Bras Enferm. 2020;73(6):e20190477. PMID: 32813804; https://doi.org/10.1590/00347167-2019-0477.
Rezoagli E, Zanella A, Cressoni M, et al. Pathogenic link between postextubation pneumonia and ventilator-associated pneumonia: an experimental study. Anesth Analg. 2017;124(4):1339-46. PMID: 28221200; https://doi.org/10.1213/ane.0000000000001899.
Barros FRB. Adesão ao bundle de prevenção de pneumonia associada à ventilação mecânica. Rev Cuid. 2019;10(2):e746. https://doi.
org/10.15649/cuidarte.v10i2.746.
Rutala WA, Weber DJ. Disinfection and sterilization in health care facilities: An overview and current issues. Infect Dis Clin North Am. 2016;30(3):609-37. PMID: 27515140; https://doi.org/10.1016/j.idc.2016.04.002.
Stabile Jr SL, Cicarelli DD, Momi T, Pagnocca ML. Avaliação da contaminação do circuito respiratório do aparelho de anestesia. Braz J Anesthesiol. 1998;48(6):492-500. Available from: https://www.bjansba.org/article/5e498c140aec5119028b492c/pdf/rba-48-6-492.pdf. Accessed in 2023 (Jun. 1).
Dubler S, Zimmermann S, Fischer M, et al. Bacterial and viral contamination of breathing circuits after extended use – an aspect of patient safety? Acta Anaesthesiol Scand. 2016;60(9):1251-60. PMID: 27470996; https://doi.org/10.1111/aas.12768.
Munoz-Price LS, Bowdle A, Johnston BL, et al. Infection prevention in the operating room anesthesia work area. Infect Control Hosp Epidemiol. 2019;40(1):1-17. PMID: 30526699; https://doi.org/10.1017/ ice.2018.303.
La Combe B, Mahérault AC, Messika J, et al. Oropharyngeal bacterial colonization after chlorhexidine mouthwash in mechanically ventilated critically ill patients. Anesthesiology. 2018;129(6):1140-8. PMID: 30247201; https://doi.org/10.1097/aln.0000000000002451.
Porto AO, Leal CBM, Ferreira RBS. Processo de enfermagem aplicado ao paciente com infecção de sítio cirúrgico pós-prostatectomia: relato de experiência. Rev Pre Infec e Saúde. 2018;4:7215. https://doi. org/10.26694/repis.v4i0.7215.
Macedo CE. Contaminação de equipamentos e superfícies na área de trabalho de anestesia da sala de operação. (dissertation). Campo Grande: Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul; 2022. Available from: https://repositorio.ufms.br/ handle/123456789/4664. Accessed in 2023 (Jun. 1).
Giroti ALB, Ferreira AM, Cury ERJ, Rigotti MA, Carneiro LM, Diniz MO. Management of mattresses in the prevention of healthcare-associated infection: a cross-sectional study. Rev Prev Infec Saúde. 2023;9(1):3872. https://doi.org/10.26694/repis.v8i1.3872.
Kanamori H, Rutala WA, Gergen MF, Weber DJ. Perioperative bacterial contamination from patients on contact precaution in operating room environment. Open Forum Infect Dis. 2020;7(11):ofaa508. PMID: 33244480; https://doi.org/10.1093/ofid/ofaa508.
Azi LMTA, Fonseca NM, Linard LG. SBA 2020: Regional anesthesia safety recommendations update. Braz J Anesthesiol. 2020;70(4):398-418. PMID: 32636024; https://doi.org/10.1016/j.bjan.2020.02.005.
Harrison GR. The contamination of volatile anaesthetics in an in-circle vaporiser with water during prolonged closed-circle anaesthesia. Anaesthesia. 2000;55(8):791-2. PMID: 10947694; https://doi.org/10.1046/ j.1365-2044.2000.01131.x.
Balkissoon R, Nayfeh T, Adams KL, et al. Microbial surface contamination after standard operating room cleaning practices following surgical treatment of infection. Orthopedics. 2014;37(4):e339-44. PMID: 24762837; https://doi.org/10.3928/01477447-20140401-53.
Biddle CJ, George-Gay B, Prasanna P, Hill EM, Davis TC, Verhulst B. Assessing a Novel Method to Reduce Anesthesia Machine Contamination: A Prospective, Observational Trial. Can J Infect Dis Med Microbiol. 2018;2018:1905360. PMID: 29623137;; https://doi. org/10.1155/2018/1905360
Biddle C, Robinson K, Pike B, et al. Quantifying the rambunctious journey of the anesthesia provider’s hands during simulated, routine care. Am J Infect Control. 2016;44(8):873-8. PMID: 27040571; https:// doi.org/10.1016/j.ajic.2016.02.014.
Spertini V, Borsoi L, Berger J, et al. Bacterial contamination of anesthesia machines’ internal breathing-circuit-systems. GMS Krankenhhyg Interdiszip. 2011;6(1):doc14. PMID: 22242095; https://doi.org/10.3205/dgkh000171.
Arai LAC, Azevedo RB. Contaminação do aparelho de anestesia por agentes patógenos. Rev Bras Anestesiol. 2011;61(1):54-9. https://doi.org/10.1590/S0034-70942011000100006.
Murray PR. Princípios Básicos da Microbiologia Médica. In: Murray PR. Microbiologia Médica. Rio de Janeiro: Guanabara Koogan; 2004. p. 5-80.
Ribeiro DC, Lopes CR, Lima RZ, Teixeira YCN. Comparação da resistência imposta pelos filtros artificiais durante a ventilação mecânica. Arq Med ABC. 2007;32(suppl 2):s42-6. Available from: https://www.portalnepas. org.br/amabc/article/view/218. Accessed in 2023 (Jun. 1).
Siqueira TB, Costa JC, Tavares IC, et al. Respiratory mechanics of neurological patients undergoing mechanical ventilation under water heated humidifier and a heat exchanger filter model. Rev Bras Ter Intensiva. 2010;22(3):264-9. PMID: 25302433.
Tablan OC, Anderson LJ, Besser R, et al. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53(RR-3):1-36. PMID: 15048056.
American Association of Nurse Anesthesiology. Infection prevention and control guidelines for anesthesia care. Available from: https:// www.aana.com/practice/clinical-practice/clinical-practice-resources/ infection-prevention-and-control/. Accessed in 2023 (Jun 1).
Dancer SJ. Infection control in the post-antibiotic era. Health Infect. 2013;18(2):51-60. https://doi.org/10.1071/HI12042.
Sattar SA, Maillard JY. The crucial role of wiping in decontamination of high-touch environmental surfaces: review of current status and directions for the future. Am J Infect Control. 2013;41(5 suppl):s97-104. PMID: 23622759; https://doi.org/10.1016/j.ajic.2012.10.032.
Rozenbaum MH, Pechlivanoglou P, van der Werf TS, et al. The role of Streptococcus pneumoniae in community-acquired pneumonia among adults in Europe: a meta-analysis. Eur J Clin Microbiol Infect Dis. 2013;32(3):305-16. PMID: 23242464; https://doi.org/10.1007/s10096-012-1778-4.
Corrêa RA, Costa NA, Lundgren F, et al. Recomendações para o manejo da pneumonia adquirida na comunidade 2018. J Bras Pneumol.
;44(5):405-23. https://doi.org/10.1590/s1806-37562018000000130.
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