[Risk of nosocomial infection in anesthesia. General recommendations]

[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.

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

OBJECTIVES

To determine incidence rate, main characteristics and risk factors of nosocomial infections associated with anesthesia (NIAA).

STUDY DESIGN

Prospective, descriptive multicentre survey.

PATIENTS

All patients aged more than 15 years and undergoing surgery (except cardio-thoracic, ENT or ambulatory surgery) under general or regional anaesthesia.

METHODS

Voluntary participation of surgical units from public or private hospitals. Use of pre-established definitions of infections and a 72 hours postanesthetic follow-up. Anaesthesia and operation related risk factors collected. End point based on occurrence, or not, of clinical infection. Record, control, treatment and analysis of the data by Epi Info--5.0 software. Statistics used: Fischer's exact test, Mantel-Haenszel test, Anova method, Kruskall-Wallis test.

RESULTS

Among 7,300 patients belonging to 13 hospitals, 25 developed an infection (nine vascular catheter related infections, 12 respiratory tract infections, two infections of the eye and two of the mouth). Only two infections have been bacteriologically documented. The overall incidence of NIAA was 3.4 per 1,000 patients. It was significantly higher after an anaesthetic of more than 2 hours and after transfusion.

CONCLUSIONS

This first prospective survey of NIAA confirmed that nosocomial infections are a real problem in the practice of anaesthesia and the necessity to use preventive measures. A survey with a larger sample size would allow to specify the respective part of the various risk factors and to develop a risk index.