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Recommendations for Infection Control for the Practice of Anesthesiology. Developed by the ASA Committee on Occupational Health Task Force on Infection Control (Third Edition) . R2 Chitsupha Parichatpricha R2 Prapairat Hemmaraj Aj Kattiya Manomayangkul.

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recommendations for infection control for the practice of anesthesiology

Recommendations for Infection Control for the Practice of Anesthesiology

Developed by the ASA Committee on Occupational Health Task Force on Infection Control (Third Edition)

R2 ChitsuphaParichatpricha

R2 PrapairatHemmaraj

AjKattiyaManomayangkul

prevention of healthcare associated infection in patients
Prevention of Healthcare-Associated Infection in Patients

Prevention of Occupational Transmission of Infection to Anesthesiologists

prevention of healthcare associated infection in patients1
Preventionof Healthcare-Associated Infection in Patients
  • A. Hand Hygiene
  • B. Preventing Contamination of Medications
  • C. Prevention of Surgical Site Infection
prevention of healthcare associated infection in patients2
Prevention of Healthcare-Associated Infection in Patients
  • D. Prevention of Intravascular Catheter-Related Infection
  • E. Prevention of Infection Associated with NeuraxialProcedures
slide12

Methods:

  • Following 5 observers pose as nursing staff in an academic center
  • observed the Hand-hygeineof anesthesia providers
  • 4-week period throughout the perioperative period
b preventing contamination of medications and fluids
B. Preventing Contamination of Medications and Fluids

Safe Injection Practices

Aseptic technique

Category IA

slide15

3. Single-dose vials (SDVs) Category IA

4. Multi-dose vials (MDVs)

Category IA

slide16

5. Fluid infusion and administration sets (i.e. intravenous bags, tubing, and connectors)

Category IB

slide21

Alcohol-basedcleanser deployed

by squeezing device

Deviceworn by provider

The Sprixx GJ device (Harbor MedicalInc., Santa Barbara, CA)

c prevention of surgical site infections
C. Prevention of Surgical Site Infections

Glucose control

Nicotine use

Hair removal

Preoperative Considerations

Transfusion

Antiseptic shower

Antimicrobial prophylaxis

c prevention of surgical site infections1
C. Prevention of Surgical Site Infections

Operating Room Ventilation

Normothermia

Cleaning

Intraoperative Considerations

Surgical attire

Asepsis and surgical technique

c prevention of surgical site infections2
C. Prevention of Surgical Site Infections

Postoperative Considerations

Postoperative Incision Care

d prevention of intravascular catheter related infections
D. Prevention of Intravascular Catheter-Related Infections

General Considerations

1. Hand hygiene

2. Aseptic technique

3. Catheter site care

4. Dressing regimens

5. Replacement of administration sets

slide28

iii.

Central Venous Catheters

1. Catheter selection

2. Insertion

3. Barrier precautions

4. Catheter replacement

5. Pressure transducers

6. Catheter site dressing

slide30

epidural abscess 1 :145,000

  • Meningitis 0.2 -1.3 : 10,000
  • Post-duralpuncture meningitis manifests 6-36 hours after dural puncture
  • symptoms : fever, back pain/tenderness and radicular pain leading to weakness and paralysis
prevention of occupational transmission of infection to anesthesiologists
Prevention of Occupational Transmission of Infection to Anesthesiologists
  • Needlestick/Sharps Safety
  • Transmission-based Precautions
  • Bloodborne Pathogens (hepatitis B virus, hepatitis C virus, human immunodeficiency virus)
  • Tuberculosis (TB)
needleless device
Needleless device

needleless intravenous access systems

devices with safety protection features
Devices with safety protection features

scalpels with safety-activated blade covers

self-sheathing needles

devices with safety protection features1
Devices with safety protection features

Syringe with a Retractable Needle

safety intravenous catheters

sharp disposal container
Sharp disposal container
  • Puncture-resistant, leak-proof containers  located closely ,sealed and replaced before completely filled
mode of transmission
Mode of transmission
  • Direct contact transmission
    • Blood , secretion, mucous membrane
  • Indirect contact transmission
    • Enviromental surface, clothing
  • Droplet transmission
    • Coughs, sneezes, talks, sings,intubation,suctioning
  • Airborne transmission
    • Droplet nuclei (<= 5 micron)
isolation precautions
Isolation precautions

Isolation precautions

Transmission-based

precautions

Standard precautions

  • Airborne precaution
  • Droplet precaution
  • Contact precaution
slide44

Standard precautions and

  • Private
  • 3 feet between patients
  • Signage outside room
  • Gown and glove
  • Face and eye protection
  • Remove gloves and gown before exiting room.
  • Avoid self-contamination
  • Perform hand hygiene after removal of PPE.
  • Dedicated patient equipment
  • Clean equipment prior to its use with other patients.
  • Cleaning of room
  • Maintain transport and entire perioperative period.
  • Communicate
droplet precautions
Droplet precautions

mumps

pertussis

Rubella=German measles

diphtheria

slide46

Single

3 feet.

HCWssurgical mask, gloves, gown, and eye protection

Patientstandard mask

Respiratory hygiene/cough etiquette.

Communicate precaution level

airborne precaution
Airborne precaution

Measles

Chicken pox

slide49

Airborne infectious isolation room(AIIR)

  • N95 for HCW
  • Standard surgical mask for patient
  • Door closed all time
  • Postponed elective procedure
  • Signage and communication
airborne infection isolation room aiir
Airborne infection isolation room (AIIR)
  • Negative pressure
  • Door close all-time
  • 6-12 air exchanges per hour (ACH).
  • Air exhausted directly to the outside or recirculated through a HEPA filter.
blood borne pathogens hbv hcv hiv
Blood borne Pathogens (HBV, HCV, HIV)

Recommendation

  • All anesthesiologists should be vaccinated and have documented immunity to hepatitis B virus (HBV).
  • Standard precautions
  • Sharps safety
  • Post-exposure prophylaxis guideline
tuberculosis
Tuberculosis

Elective Surgery for Patients with Active TB Infection

Recommendation

  • Postponed until the patient is no longer infectious.
tuberculosis1
Tuberculosis

Urgent/Emergent Surgery for Patients with Active TB Infection

Recommendation

  • Airborne Precautions
tuberculosis2
Tuberculosis
  • N95 (or higher protection factor)
  • Filters with an efficiency rating of >95% for particle sizes of 0.3 μmon the Anesthesia Breathing Circuit
  • Recover in a respiratory isolation room or in the OR
tuberculosis3
Tuberculosis

TB Screening Programs for HCWs

Recommendation

  • Baseline screening and yearly testing
    • a tuberculin skin test (TST)
    • a QuantiFERON®-TB Gold (QFT-G) blood test.
  • Positive TST-> chest radiography and review of symptoms
  • Exposed to TB screened shortly after the exposure and again in 12 weeks
emerging infectious diseases pandemic influenza
Emerging Infectious Diseases/Pandemic Influenza
  • Droplet precaution VS airborne precaution VS contact precaution
  • Vaccination against H1N1 and seasonal influenzain all healthcare workers
operating room
Operating room
  • Set OR for emergency and urgency case
  • Limiting the personnel involved in the case
  • Choosing an operating suite remote from others
  • Remove all unnecessary equipment
  • Full PPE
  • Recovery of the patient should be in isolation.
  • PPE should be disposed of upon leaving the OR
  • The anesthesia circuit and gas sampling line should be disposed of at the conclusion of the case.
  • All surfaces should be disinfected with an agent approved by the Environmental Protection Agency (EPA).14,17
slide58

Immunization of Health-Care Workers Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC)

strongly recommendations for hcw
Strongly recommendations for HCW
  • BCG
  • Hepatitis B
  • Influenza
  • MMR
  • Varicella-zoster
hepatitis b
Hepatitis B
  • No serologic evidence of immunity or prior vaccination
influenza
Influenza

Get 1 dose of influenza vaccine annually

mmr measles mumps rubella
MMR(measles, mumps, rubella)
  • No serologic evidence of immunity or previous vaccination
  • Get 2 dose of MMR , 4week apart
varicella zoster chicken pox
Varicella-zoster (chicken pox)
  • No serologic evidence of immunity or previous vaccination

Get 2 dosed of varicella vaccine , 4 weeks apart