Multiple Reservoirs Contribute to Intraoperative Bacterial Transmission
- 1 June 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesia & Analgesia
- Vol. 114 (6), 1236-1248
- https://doi.org/10.1213/ane.0b013e31824970a2
Abstract
BACKGROUND: Intraoperative stopcock contamination is a frequent event associated with increased patient mortality. In the current study we examined the relative contributions of anesthesia provider hands, the patient, and the patient environment to stopcock contamination. Our secondary aims were to identify risk factors for stopcock contamination and to examine the prior association of stopcock contamination with 30-day postoperative infection and mortality. Additional microbiological analyses were completed to determine the prevalence of bacterial pathogens within intraoperative bacterial reservoirs. Pulsed-field gel electrophoresis was used to assess the contribution of reservoir bacterial pathogens to 30-day postoperative infections. METHODS: In a multicenter study, stopcock transmission events were observed in 274 operating rooms, with the first and second cases of the day in each operating room studied in series to identify within- and between-case transmission events. Reservoir bacterial cultures were obtained and compared with stopcock set isolates to determine the origin of stopcock contamination. Between-case transmission was defined by the isolation of 1 or more bacterial isolates from the stopcock set of a subsequent case (case 2) that were identical to reservoir isolates from the preceding case (case 1). Within-case transmission was defined by the isolation of 1 or more bacterial isolates from a stopcock set that were identical to bacterial reservoirs from the same case. Bacterial pathogens within these reservoirs were identified, and their potential contribution to postoperative infections was evaluated. All patients were followed for 30 days postoperatively for the development of infection and all-cause mortality. RESULTS: Stopcock contamination was detected in 23% (126 out of 548) of cases with 14 between-case and 30 within-case transmission events confirmed. All 3 reservoirs contributed to between-case (64% environment, 14% patient, and 21% provider) and within-case (47% environment, 23% patient, and 30% provider) stopcock transmission. The environment was a more likely source of stopcock contamination than provider hands (relative risk [RR] 1.91, confidence interval [CI] 1.09 to 3.35, P = 0.029) or patients (RR 2.56, CI 1.34 to 4.89, P = 0.002). Hospital site (odds ratio [OR] 5.09, CI 2.02 to 12.86, P = 0.001) and case 2 (OR 6.82, CI 4.03 to 11.5, P \u3c 0.001) were significant predictors of stopcock contamination. Stopcock contamination was associated with increased mortality (OR 58.5, CI 2.32 to 1477, P = 0.014). Intraoperative bacterial contamination of patients and provider hands was linked to 30-day postoperative infections. CONCLUSIONS: Bacterial contamination of patients, provider hands, and the environment contributes to stopcock transmission events, but the surrounding patient environment is the most likely source. Stopcock contamination is associated with increased patient mortality. Patient and provider bacterial reservoirs contribute to 30-day postoperative infections. Multimodal programs designed to target each of these reservoirs in parallel should be studied intensely as a comprehensive approach to reducing intraoperative bacterial transmissionThis publication has 29 references indexed in Scilit:
- The impact of enhanced cleaning within the intensive care unit on contamination of the near-patient environment with hospital pathogens: A randomized crossover study in critical care units in two hospitals*Critical Care Medicine, 2011
- Hand Contamination of Anesthesia Providers Is an Important Risk Factor for Intraoperative Bacterial TransmissionAnesthesia & Analgesia, 2011
- Nasal decolonization of Staphylococcus aureus with mupirocin: strengths, weaknesses and future prospectsJournal of Antimicrobial Chemotherapy, 2009
- Reduction in Intraoperative Bacterial Contamination of Peripheral Intravenous Tubing Through the Use of a Novel DeviceAnesthesiology, 2009
- Staphylococcus aureus intestinal colonization is associated with increased frequency of S. aureuson skin of hospitalized patientsBMC Infectious Diseases, 2007
- Catheter-related Bacteremia and Multidrug-resistantAcinetobacter lwoffiiEmerging Infectious Diseases, 2007
- Nasal Carriage as a Source ofStaphylococcus aureusBacteremiaThe New England Journal of Medicine, 2001
- Insights into the Epidemiology and Control of Infection with Vancomycin‐Resistant EnterococciClinical Infectious Diseases, 2000
- Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous cathetersThe American Journal of Medicine, 1991
- Clinical Experience with the Multiple Lumen Central Venous CatheterJournal of Parenteral and Enteral Nutrition, 1986