[Surveillance of nosocomial infections related to anesthesia. A multicenter study]

[Assessment of hygiene practices in anaesthesia between 1998 and 2007 in Lorraine]

OBJECTIVES

To study the assessment of hygiene practices in anaesthesia in Lorraine between 1998 and 2007, after recommendations from the French Society of Anaesthesia and Reanimation (SFAR) in December 1997, and different local actions.

STUDY DESIGN

Two surveys performed at a nine-year interval in Lorraine hospitals.

POPULATION AND METHOD

Questionnaires about risk infection management and hygiene practices were sent by post to all anaesthetists, nurse anaesthetists and recovery room nurses in 1998 (n=279) and in 2007 (n=259).

RESULTS

Between the two surveys multidrug-resistant bacteria signalling, movements of the staff in operating rooms, septic isolation protocol and management of single-use disposable anaesthesia material have been improved (p<0.05). Central venous catheters are less performed in recovery rooms and rings wearing decreased by 16% (p<0.05). Wearing of nonsterile gloves for peripheral venous catheter and intubation is not generalized (p<0.05). About half of the hospitals have cleanup procedures of anaesthesia furniture. Washing of hands by anaesthesia staff is not sometimes respected but it's more frequent for medicine preparation and between two operations. A good skin disinfection (cleaning - rinsing - drying - antiseptic) is more recurrent in 2007 (61.4%) than in 1998 (41.9%) for arterial catheter. Wearing of glasses for intubation is each times rare, about 15%.

CONCLUSION

Hygiene practices in anaesthesia in Lorraine have been improved between the two surveys by recommendations from the Sfar and the work of the Antenne Régional de Lorraine (audits, manuals, formations). Promising progress has been made but some points must still be worked on.

Propofol EDTA and reduced incidence of infection

Propofol formulated in a lipid vehicle supports the growth of microorganisms. There have been worldwide reports of extrinsic microbial contamination of propofol leading to outbreaks of serious postoperative nosocomial infections. Therefore it is essential that medical professionals follow strict aseptic precautions when handling propofol, as recommended by manufacturers of propofol and the Centers for Disease Control and Prevention. Non-adherence to these recommendations increases the risk of nosocomial postoperative infections, which impose a heavy burden of morbidity and mortality and have serious economic consequences. It has also been recommended that the use of EDTA-containing formulations of propofol be considered. In vitro studies have confirmed that EDTA added to propofol retards microbial growth. Data on the incidence of nosocomial infections before and after the introduction of propofol with EDTA indicates that there have been no further cluster outbreaks and individual nosocomial infections appear to have been reduced. The addition of EDTA is an additional safety precaution to good aseptic practice.

[Airway equipment and its maintenance for a non difficult adult airway management (endotracheal intubation and its alternative: face mask, laryngeal mask airway, laryngeal tube)]

The airway equipment for a non difficult adult airway management are described: endotracheal tubes with a specific discussion on how to inflate the balloon, laryngoscopes and blades, stylets and intubation guides, oral airways, face masks, laryngeal mask airways and laryngeal tubes. Cleaning and disinfections with the maintenance are also discussed for each type of airway management.

[Is length of stay in the recovery room a risk factor for cross infections?]

OBJECTIVE

To assess cross contamination for patients at the time of their stay in the recovery room (RR).

STUDY DESIGN

Prospective study.

PATIENTS AND METHODS

A prospective survey over 3 weeks with 75 adult patients admitted to RR after thoracic or neck surgery. Samples for bacterial analysis were systematically taken from all patients before they left the operating theatre and just before discharge of RR (nose-throat and skin adjacent to the surgical wound). During this period, hand's health care workers (HCW) and environmental surfaces were sampled.

RESULTS

There were 3 groups of patients: endoscopy (41%), thoracic surgery (39%). And thyroidectomy (20%), 392 samples were analysed. Potentially pathogenic floras were found on the admission for 25 patients and at discharge for 31 patients. A pathogenic flora was detected at discharge in 13 patients, whereas none was found at admission in RR. These patients were principally in the thyroidectomy group and their stay in RR was longer than 20 minutes. There is no significant difference concerning the nosocomial risk between 3 groups. Pathogenic flora was found in 19% of HCW (8 of 42).

CONCLUSION

Cross contamination can exist in recovery room and educative measures are to be taken regarding handwhashing, isolation precautions and environmental cleaning.

[Evaluation of antibacterial filters for peridural obstetrical anesthesia]

OBJECTIVES

To assess the antibacterial efficiency of filters used in obstetrics when epidural top-ups are performed.

STUDY DESIGN

Observational prospective study.

PATIENTS AND METHODS

We aseptically collected 201 antibacterial filters that had been used for top-ups with ropivacaine +/- sufentanil for epidural analgesia during labour. We flushed them first with 2 mL of saline and then with 2 mL of a solution containing 1.5 x 10(6) Staphylococcus epidermidis/mL. The filtrates were incubated at 37 degrees C for 72 h. Number of top-ups and duration of epidural analgesia are expressed as median (extremes).

RESULTS

3 (1-10) top-ups were performed for labour analgesia over a period of 6.5 h (1.8-18). After filtering, all the solutions were found to be sterile. Especially, when using Staphylococcus epidermidis solutions, bacteria were not found beyond any filter. These results suggest the integrity of the filter membrane after several boluses. No infection related to epidural analgesia was reported.

CONCLUSION

Antibacterial filters provide a good protection against a potentially contaminated procedure during epidural top-ups.