Improving infection control practices of nurse anesthetists

Plemmons, Molly M. et al. | Improving infection control practices of nurse anesthetists in the anesthesia workspace | American Journal of Infection Control | published online January 18th 2019

Anesthesia providers commonly cross-contaminate their workspace and subsequently put patients at risk for a health care-acquired infection. The primary objective of this project was to determine if education and implementation of standardized infection control guidelines that address evidence-based best practices would improve compliance with infection control procedures in the anesthesia workspace.

Patient care-related hand hygiene of nurse anesthetists was observed in 3 areas of anesthesia practice before and 3 weeks and 3 months after staff education, placement of visual reminders, and the implementation of infection control guidelines. After the observation periods, the percent compliance on the part of the providers was calculated for each of the 3 areas of anesthesia practice, and the results were compared using the Fisher exact test.

There were a total of 95 observations performed during the 3 observation periods. When compared with preimplementation baseline data, there was a 26.2% increase in the number of providers compliant with hand hygiene practices after airway instrumentation (P = .029) and a 71.9% increase in the number of providers who separated clean from contaminated items in the workspace (P = .0001).

Education, visual reminders, and standardized infection control guidelines were shown to improve compliance with infection control best practices in a group of nurse anesthetists.


Can the design of glove dispensing boxes influence glove contamination?

Assadian, O. et al. The Journal of Hospital Infection. Published online: September 15 2016
Image source: Michael Coghlan – Flickr // CC BY-SA 2.0

Background: Few studies have explored the microbial contamination of glove boxes in clinical settings. The objective of this observational study was to investigate whether a new glove packaging system in which gloves are dispensed one by one vertically with the cuff-end first has lower levels of contamination on the gloves and on the surface around the box aperture compared to conventional horizontally dispensed glove boxes.

Methods: Seven participating sites were provided with vertical glove dispensing systems and conventional boxes. Before opening boxes, the surface around the aperture was sampled microbiologically to establish base-line levels of superficial contamination. Once the boxes were opened, the first pair of gloves in each box were sampled for viable bacteria. Thereafter, testing sites were visited on a weekly basis over a period of six weeks and the same microbiological assessments made.

Results: The surface surrounding the aperture of the modified dispenser boxes became significantly less contaminated than the conventional boxes (P < 0.001) with an average of 46.7% less contamination around the aperture. Overall, gloves from modified boxes showed significantly less colony-forming units contamination than gloves from conventional boxes (P < 0.001). Comparing all sites over the entire six-week period, modified dispensed gloves had 88.9% less bacterial contamination.

Conclusion: This simple improvement to glove box design reduces contamination of unused gloves. Such modifications could decrease the risk of microbial cross-transmission in settings that utilise gloves. However, such advantages do not substitute for strict hand-hygiene compliance and appropriate use of non-sterile, single-use gloves.

Read the abstract here

Acquisition of bacteria on health care workers’ hands after contact with patient privacy curtains

Larocque, M. American Journal of Infection Control. Published online: 4 July 2016


Single Sex Accommodation

  • Health care workers’ hands were imprinted before and after touching privacy curtains.
  • Half of all participants grew bacteria on their hands after touching curtains.
  • All curtain-acquired organisms were skin or oral commensal flora.
  • Hand hygiene after touching curtains is important in preventing nosocomial infection.

To determine whether pathogenic bacteria could be transferred to health care workers by touching privacy curtains, imprints of health care workers’ fingertips were obtained when participants were approached, after hand hygiene with alcohol handrub, and directly after handling curtains. Participants’ hands were heavily contaminated at baseline, in some cases with potentially pathogenic species. Half of the participants (n = 30) acquired bacteria on their fingertips from handling curtains, illustrating that privacy curtains may be involved in the transmission of infection to emergency department patients.

Read the abstract here

The influence of contaminated urine cultures in inpatient and emergency department settings

Klausing, B.T. et al. American Journal of Infection Control. Published online: 13 June 2016


  • Urine culture contamination results in substantial impact to patients.
  • Morbidity includes unnecessary testing and antibiotic exposure.
  • Reducing urine culture contamination is an important quality intervention.

We retrospectively evaluated 131 patients with contaminated urine cultures during a 12-month period. Sixty-four patients (48.8%) experienced 139 potential complications related to these specimens. The most common complication was inappropriate antibiotic administration (noted in 58 patients [44.3%]). Contaminated urine cultures led to additional diagnostic evaluation and unnecessary antibiotic use.

Read the abstract here

Decontamination of breast pump milk collection kits and related items

A variety of methods are in use for decontaminating breast pump milk collection kits and related items associated with infant feeding. This paper aims to provide best practice guidance for decontamination of this equipment at home and in hospital. It has been compiled by a joint Working Group of the Healthcare Infection Society and the Infection Prevention Society.

Full reference: Price E, Weaver G, Hoffman P et al  Decontamination of breast pump milk collection kits and related items at home and in hospital: guidance from a Joint Working Group of the Healthcare Infection Society & Infection Prevention Society J Hosp Infect. 2015 Dec 1. pii: S0195-6701(15)00352-7 [Epub ahead of print]

Wearing two sets of gloves reduces contamination in surgery

A simple intervention such as wearing double gloves and removing the outer layer after touching the patient during surgery can reduce contamination. This study tested, in a simulated environment, whether anaesthetists wearing two pairs of gloves reduced contamination in surgery. The outer set of gloves was removed immediately after placing a tube into the airway. In half of the 22 simulation sessions personnel wore a single pair of gloves and in the other half they wore two sets of gloves. Before the simulation, the lips and inside of the mouth of the mannequin were coated with a fluorescent gel to represent a pathogen. After the simulation, an observer examined 40 different sites to determine whether the ‘pathogen’ was transferred to the patient or the patient’s environment. There was a significant reduction in the rate of contamination with double gloves. Single gloves were associated with an average of 20 contaminated sites compared to five with double gloves.

Reference: Birnbach DJ, Rosen LF, Fitzpatrick M, Carling P, Arheart KL, Munoz-Price LS. Double gloves: a randomized trial to evaluate a simple strategy to reduce contamination in the operating room. Anesthesia and Analgesia. 2015 Mar;120(4):848-852