One more time: Wash. Your. Hands.

A new paper in Anesthesia and Analgesia takes a look at hand hygiene by anesthesia providers and transmission of organisms from their hands to anesthesia equipment and patients' IV stopcocks. The study was performed at Dartmouth and Kathy Kirkland was one of the authors. The study looked at 1st and 2nd cases in selected operating rooms. After cleaning, the anesthesia machine was cultured. Then the anesthesia provider's hands were cultured and after the case the anesthesia machine and patient IV stopcocks were cultured. The room was then cleaned, and the same algorithm for cultures was followed for the second case. Bioptyping of isolates was performed to determine whether the organism on the providers' hands matched the environmental isolates.

The major findings were:

• The hands of the anesthesia provider were contaminated with one or more major pathogens 66% of the time
• Bacterial transmission to the IV stopcock set occurred in 11.5% of the cases, with 47% of the isolates matching those on the anesthesia provider's hands
• Bacterial transmission to the anesthesia machine occurred in 89% of the cases, with 12% of the isolates matching those on the anesthesia provider's hands

Over the past several years much attention has been paid to improving compliance with surgical antimicrobial prophylaxis and improving hand hygiene compliance outside the OR. Moreover, surgical hand hygiene has been an integral part of the OR routine for eons. However, little attention has been paid to hand hygiene compliance by anesthesia personnel. Kathy and her colleagues have probably now changed that. Ok Anesthesia people, wash up!