Thursday, March 24, 2016

IV Line Infection Is Anesthesia's Fault Too

A new study in Anesthesiology has shown that anesthesiologists may be a significant source for IV line infection in the surgical patient. The paper's authors evaluated 303 cases that were performed by 25 anesthesiologists in New Zealand. They attached a microfilter into the IV line leading to the patient. At the end of each case, the authors collected the filters and all the syringes that were used during the case. What they found was sobering.

The authors were able to culture bacteria from over 6% of the IV filters they received. The cultures grew different Staph and Corynebacterium species, among others. They were also able to grow bacteria from the residual drugs in 2.4% of the used syringes from the operating room.The bacteria were similar to the ones inside the IV filters.

Though these percentages may seem small, remember that IV line infections in patients is supposed to be one of those never events in a hospital. So even a 2% incidence of bacteria inside the IV is a big problem. It is particularly alarming since the anesthesiologists involved in the study were aware that their aseptic techniques were being scrutinized and bacteria were still isolated from the syringe samples. However, the study concedes that it is not able to correlate the clinical relevancy of these bacterial cultures to actual patient infections.

The journal's editorial suggests that one way to reduce this contamination is to have prefilled syringes of the drugs anesthesiologists are most likely to use. This eliminates the handling of half empty vials of drugs that may have been sitting inside dirty anesthesia cart drawers. Though we despise the practice, the meticulous wiping of the rubber stoppers on top of drug bottles and IV ports for at least 15 seconds according to CMS guidelines may also decrease the likelihood of bacterial transmission.

As part of anesthesia's goals of patient safety first, these small actions on our parts may be a relatively easy and effective way to lessen the number of hospital acquired infections.

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