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. CURRENT ANESTHESIOLOGY REPORTS 2020; 10:233-241. [PMID: 32837343 PMCID: PMC7366489 DOI: 10.1007/s40140-020-00403-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
PURPOSE OF REVIEW This review aims to highlight key factors in the perioperative environment that contribute to transmission of infectious pathogens, leading to healthcare-associated infection. This knowledge will provide anesthesia providers the tools to optimize preventive measures, with the goal of improved patient and provider safety. RECENT FINDINGS Over the past decade, much has been learned about the epidemiology of perioperative pathogen transmission. Patients, providers, and the environment serve as reservoirs of origin that contribute to infection development. Ongoing surveillance of pathogen transmission among these reservoirs is essential to ensure effective perioperative infection prevention. SUMMARY Recent work has proven the efficacy of a strategic approach for perioperative optimization of hand hygiene, environmental cleaning, patient decolonization, and intravascular catheter design and handling improvement protocols. This work, proven to generate substantial reductions in surgical site infections, can also be applied to aide prevention of SARS-CoV-2 spread in the COVID-19 era.
Collapse
Affiliation(s)
- Archit Sharma
- Department of Anesthesia, University of Iowa, 200 Hawkins Drive, 6512 JCP, Iowa City, IA 52242 USA
| | - Patrick G. Fernandez
- Department of Anesthesia, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 E. 16th Ave, Aurora, CO 80045 USA
| | - John P. Rowlands
- Delaware Orthopaedic Specialists, Pain Management, 3401 Brandywine Parkway, Wilmington, DE 19803 USA
| | - Matthew D. Koff
- Department of Anesthesia and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH 03756 USA
| | - Randy W. Loftus
- Department of Anesthesia, University of Iowa, 200 Hawkins Drive, 6512 JCP, Iowa City, IA 52242 USA
| |
Collapse
|
2
|
Wise ME, Bancroft E, Clement EJ, Hathaway S, High P, Kim M, Lutterloh E, Perz JF, Sehulster LM, Tyson C, White-Comstock MB, Montana B. Infection Prevention and Control in the Podiatric Medical Setting. Challenges to Providing Consistently Safe Care. J Am Podiatr Med Assoc 2015; 105:264-72. [PMID: 26146975 DOI: 10.7547/0003-0538-105.3.264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Unsafe practices are an underestimated contributor to the disease burden of bloodborne viruses. Outbreaks associated with failures in basic infection prevention have been identified in nonhospital settings with increased frequency in the United States during the past 15 years, representing an alarming trend and indicating that the challenge of providing consistently safe care is not always met. As has been the case with most medical specialties, public health investigations by state and local health departments, and the Centers for Disease Control and Prevention, have identified some instances of unsafe practices that have placed podiatric medical patients at risk for viral, bacterial, and fungal infections. All health-care providers, including podiatric physicians, must make infection prevention a priority in any setting in which care is delivered.
Collapse
Affiliation(s)
- Matthew E. Wise
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth Bancroft
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
| | - Ernest J. Clement
- Bureau of Healthcare Associated Infections, New York State Department of Health, Albany, NY
| | - Susan Hathaway
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
| | - Patricia High
- Public Health Nursing, Clinic Services, Ocean County Health Department, Toms River, NJ
| | - Moon Kim
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
| | - Emily Lutterloh
- Bureau of Healthcare Associated Infections, New York State Department of Health, Albany, NY
| | - Joseph F. Perz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lynne M. Sehulster
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Clara Tyson
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
| | - Mary Beth White-Comstock
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Barbara Montana
- Communicable Disease Service, New Jersey Department of Health, Trenton, NJ
| |
Collapse
|
3
|
Loftus RW, Koff MD, Birnbach DJ. The Dynamics and Implications of Bacterial Transmission Events Arising from the Anesthesia Work Area. Anesth Analg 2015; 120:853-60. [DOI: 10.1213/ane.0000000000000505] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
4
|
Abstract
One consequence of the global HIV/AIDS pandemic has been the emergence of a broad awareness of the potential role of syringes in the transmission of infectious diseases. In addition to HIV/AIDS, the use of unsterile syringes by multiple persons has been linked to the spread of Hepatitis B, Hepatitis C, Leishmaniasis, malaria and various other infections. The purpose of this paper is to extend awareness of the grave risks of multiperson syringe use by examining the role of this behavior in the development of infectious disease syndemics. The term syndemics refers to the clustering, often due to noxious social conditions, of two or more diseases in a population resulting in adverse disease synergies that impact human life and well-being. The contemporary appearance and spread of identified syringe-mediated syndemics, and the potential for the emergence of future syringe-mediated syndemics, both of which are reviewed in this paper, underline the importance of public health measures designed to limit syringe-related disease transmission.
Collapse
Affiliation(s)
- Nicola Bulled
- Department of Anthropology, University of Connecticut, Storrs, 06269-2176, USA.
| | | |
Collapse
|
5
|
US outbreak investigations highlight the need for safe injection practices and basic infection control. Clin Liver Dis 2010; 14:137-51; x. [PMID: 20123446 DOI: 10.1016/j.cld.2009.11.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Current understanding of viral hepatitis transmission in United States health care settings indicates progress over the past several decades with respect to the risks from transfusions or blood products. Likewise, risks to health care providers from sharps injuries and other blood and body fluid exposures have been reduced as a consequence of widespread hepatitis B vaccination and the adoption of safer work practices. Increasing recognition of outbreaks involving patient-to-patient spread of hepatitis B and hepatitis C virus infections, however, has uncovered a disturbing trend. This article highlights the importance of basic infection control and the need for increased awareness of safe injection practices.
Collapse
|
6
|
|
7
|
Kotwal A. Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices. Soc Sci Med 2005; 60:1133-47. [PMID: 15589680 DOI: 10.1016/j.socscimed.2004.06.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The rapid uptake of the hypodermic syringe as a medical technology by physicians in Europe and America since its introduction in the middle of the 19th century has led to a level of medical and public acceptance seldom reached by other therapeutic techniques. Presently, the developed world has clear guidelines regarding injection use and safety; in contrast, developing countries are facing the brunt of risks associated with the use of this technology, which was introduced into their societies during the early 20th century. There is now a popular demand for injections, and an alarming number of unnecessary and unsafe injections are being administered. The problem of unsafe injections is not restricted to curative injections, but includes immunizations too. The association of unsafe injections and infection transmission is quite clear, and there is an urgent need to reduce the number of required injections and make them safe. An understanding of the determinants of current injection practices in the socio-cultural-economic context is necessary in order to plan relevant and effective interventions.
Collapse
Affiliation(s)
- Atul Kotwal
- Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, New Delhi 110067, India.
| |
Collapse
|
8
|
Comstock RD, Mallonee S, Fox JL, Moolenaar RL, Vogt TM, Perz JF, Bell BP, Crutcher JM. A large nosocomial outbreak of hepatitis C and hepatitis B among patients receiving pain remediation treatments. Infect Control Hosp Epidemiol 2004; 25:576-83. [PMID: 15301030 DOI: 10.1086/502442] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND OBJECTIVE In August 2002, the Oklahoma State Department of Health received a report of six patients with unexplained hepatitis C virus (HCV) infection treated in the same pain remediation clinic. We investigated the outbreak's extent and etiology. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective cohort study of clinic patients, including a serologic survey, interviews of infected patients, and reviews of medical records and staff infection control practices. Patients received outpatient pain remediation treatments one afternoon a week in a clinic within a hospital. Cases were defined as HCV or hepatitis B virus (HBV) infections among patients who reported no prior diagnosis or risk factors for disease or reported previous risk factors but had evidence of acute infection. RESULTS Of 908 patients, 795 (87.6%) were tested, and 71 HCV-infected patients (8.9%) and 31 HBV-infected patients (3.9%) met the case definition. Multiple HCV genotypes were identified. Significantly higher HCV infection rates were found among individuals treated after an HCV-infected patient during the same visit (adjusted odds ratio [AOR], 6.2; 95% confidence interval [CI95], 2.4-15.8); a similar association was observed for HBV (AOR, 2.9; CI95, 1.3-6.5). Review of staff practices revealed the nurse anesthetist had been using the same syringe-needle to sequentially administer sedation medications to every treated patient each clinic day. CONCLUSIONS Reuse of needles-syringes was the mechanism for patient-to-patient transmission of HCV and HBV in this large nosocomial outbreak. Further education and stricter oversight of infection control practices may prevent future outbreaks.
Collapse
Affiliation(s)
- R Dawn Comstock
- Oklahoma State Department of Health, Oklahoma City, Oklahoma 73117, USA
| | | | | | | | | | | | | | | |
Collapse
|
9
|
TILLEY JH. Infective hepatitis in a mixed school, with high attack rate in females. BRITISH MEDICAL JOURNAL 1998; 2:1354-6. [PMID: 13776903 PMCID: PMC2097172 DOI: 10.1136/bmj.2.5209.1354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
10
|
|
11
|
Lutz CT, Bell CE, Wedner HJ, Krogstad DJ. Allergy testing of multiple patients should no longer be performed with a common syringe. N Engl J Med 1984; 310:1335-7. [PMID: 6371529 DOI: 10.1056/nejm198405173102024] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
12
|
Hare R. The scientific activities of Alexander Fleming, other than the discovery of penicillin. MEDICAL HISTORY 1983; 27:347-72. [PMID: 6358724 PMCID: PMC1140044 DOI: 10.1017/s0025727300043386] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
13
|
|
14
|
Plueckhahn VD, Banks J. Fatal haemolytic streptococcal septicaemia following mass inoculation with influenza vaccine. Med J Aust 1970; 1:405-11. [PMID: 5445853 DOI: 10.5694/j.1326-5377.1970.tb77962.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
15
|
Trotman RE. Sterilization by radiofrequency induction heating: a method for the in situ sterilization of vessels in automatic bacteriological apparatus. THE JOURNAL OF APPLIED BACTERIOLOGY 1969; 32:297-300. [PMID: 4904964 DOI: 10.1111/j.1365-2672.1969.tb00975.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
16
|
CHILD welfare centres: present and future needs. BRITISH MEDICAL JOURNAL 1955; 1:235-6. [PMID: 14363870 PMCID: PMC2061995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
|
17
|
HEARD BE. An experimental study of the changes taking place in homogenous whole blood clot introduced into the pleural sac of the rat. THE JOURNAL OF PATHOLOGY AND BACTERIOLOGY 1953; 66:359-63. [PMID: 13118440 DOI: 10.1002/path.1700660204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
18
|
|
19
|
|