Thoughts?

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It would be interesting to know if the DNA sequencing of the anesthesia machine bacteria, and all other sources of bacteria were compared with the DNA sequencing of the infected patient bacteria.....
 
There's a difference between simple, cheap, common sense measures that probably have a good cost to effectiveness ratio...like hand washing and keeping drug injection ports clean...and silly, wasteful, and expensive measures like covering the entire anesthesia machine in a condom. What happens when that condom breaks?
 
GravelRider said:
Unless you are able to pull out in time...and I obviously mean pull the machine out of the room and replace it with a freshly covered and cleaned machine.
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It's easier to just finish like nothing happened and then get some "morning after" antibiotics the next day.
 
Anybody clean their disgusting germ ridden pens and phone between cases? I never have. Where can I get condoms for them too?
 
nimbus said:
Anybody clean their disgusting germ ridden pens and phone between cases? I never have. Where can I get condoms for them too?
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I clean my phone often. I rub that thing on my face all the time.
 
nimbus said:
Anybody clean their disgusting germ ridden pens and phone between cases? I never have. Where can I get condoms for them too?
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I cleaned all 3 of my pens today, and my phone, with alcohol swab. Patient wasn't septic or anything, but has been an inpatient for a month in the ICU, trached, PEGed, 100kg, doesn't move, lots of tubes/lines (central, EVD, arterial, infusions, etc) lots of secretions from trach/mouth. So it didn't feel that clean to me. I used my pen w/o taking off my glove to label syringes and stuff, so i cleaned it afterwards. I even wiped down the machine and computer after i transported patient back to ICU
 
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Just look at the way many practitioners actually practice. Wear gloves. Stick fingers of right hand in the mouth to open. Grab laryngoscope handle that may or may not be on sterile towel on anesthesia machine with dirty right hand. Transfer laryngoscope to left hand. Use right hand to adjust laryngeal view. Ask assistant who may or may not be gloved to apply pressure on now dirty neck. Intubate. Place laryngoscope, now dirty on cart. Maybe on towel. Maybe not. Squeeze bag with dirty right hand. use dirty right hand to flip switch to vent. Use dirty right hand to adjust vaporizer input, ventilator settings, maybe on touch screen if new machine maybe not. Maybe need different size airway or different blade, use dirty right hand hand to open drawer to cart. Touch inside of drawer. I am sure that there is absolute first rate in "wiping down" anesthesia machine and cart and drawers between cases everywhere.😉. Is it really so hard to imagine that just maybe anesthesia care is responsible for at least some infections?
 
dr doze said:
Just look at the way many practitioners actually practice. Wear gloves. Stick fingers of right hand in the mouth to open. Grab laryngoscope handle that may or may not be on sterile towel on anesthesia machine with dirty right hand. Transfer laryngoscope to left hand. Use right hand to adjust laryngeal view. Ask assistant who may or may not be gloved to apply pressure on now dirty neck. Intubate. Place laryngoscope, now dirty on cart. Maybe on towel. Maybe not. Squeeze bag with dirty right hand. use dirty right hand to flip switch to vent. Use dirty right hand to adjust vaporizer input, ventilator settings, maybe on touch screen if new machine maybe not. Maybe need different size airway or different blade, use dirty right hand hand to open drawer to cart. Touch inside of drawer. I am sure that there is absolute first rate in "wiping down" anesthesia machine and cart and drawers between cases everywhere.😉. Is it really so hard to imagine that just maybe anesthesia care is responsible for at least some infections?
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And then place that dirty hand in the open sterile wound?
 
anbuitachi said:
I cleaned all 3 of my pens today, and my phone, with alcohol swab. Patient wasn't septic or anything, but has been an inpatient for a month in the ICU, trached, PEGed, 100kg, doesn't move, lots of tubes/lines (central, EVD, arterial, infusions, etc) lots of secretions from trach/mouth. So it didn't feel that clean to me. I used my pen w/o taking off my glove to label syringes and stuff, so i cleaned it afterwards. I even wiped down the machine and computer after i transported patient back to ICU
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That's a first. I've never seen or heard of anybody cleaning a pen until now.
 
dr doze said:
Just look at the way many practitioners actually practice. Wear gloves. Stick fingers of right hand in the mouth to open. Grab laryngoscope handle that may or may not be on sterile towel on anesthesia machine with dirty right hand. Transfer laryngoscope to left hand. Use right hand to adjust laryngeal view. Ask assistant who may or may not be gloved to apply pressure on now dirty neck. Intubate. Place laryngoscope, now dirty on cart. Maybe on towel. Maybe not. Squeeze bag with dirty right hand. use dirty right hand to flip switch to vent. Use dirty right hand to adjust vaporizer input, ventilator settings, maybe on touch screen if new machine maybe not. Maybe need different size airway or different blade, use dirty right hand hand to open drawer to cart. Touch inside of drawer. I am sure that there is absolute first rate in "wiping down" anesthesia machine and cart and drawers between cases everywhere.😉. Is it really so hard to imagine that just maybe anesthesia care is responsible for at least some infections?
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Agree the cart is contaminated inside and out. The only part that may occasionally get cleaned is the top surface. Maybe we need single use preloaded carts for each case. How far will we take this? A condom for the anesthesia machine makes no sense in this globally contaminated environment. Or maybe we're not causing surgical site infections and it doesn't really matter. I'd like to see a study before it is implemented. A lot of stuff that intuitively makes sense don't pan out to be true.
 
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nimbus said:
Agree the cart is contaminated inside and out. The only part that may occasionally get cleaned is the top surface. Maybe we need single use preloaded carts for each case. How far will we take this? A condom for the anesthesia machine makes no sense in this globally contaminated environment. Or maybe we're not causing surgical site infections and it doesn't really matter. I'd like to see a study before it is implemented. A lot of stuff that intuitively makes sense don't pan out to be true.
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I second this. So many things are evidence based these days, and dictate standard of care often. But some rules and regulations seem to be anecdotal, without evidence, but because in theory, and logically it makes sense, its enforced nonetheless.
 
jlquick said:
I second this. So many things are evidence based these days, and dictate standard of care often. But some rules and regulations seem to be anecdotal, without evidence, but because in theory, and logically it makes sense, its enforced nonetheless.
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I said intuitively because logically it doesn't make sense for the reasons I described above.
 
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Lots wrong with that machine condom. For example, Say you're bagging patient and your bag pops off and falls to floor. When you try to put the bag back on, the plastic machine condom gets caught between the the opening of the bag and the arm of the circuit, occluding flow into and out of the bag. Messing around with that nonsense on induction or if patient is in laryngospasm, etc isn't something I'm interested in. One of the hospitals I'm at has touch screen monitors, will the bag interfere with that?

I routinely wipe the machine surfaces, vaporizors, fresh gas flow knobs, cart surfaces etc off even if I have a tech I know is doing it too. I change a sterile towel to put my airway equipment on between every case. It takes 1-2 minutes. Pretty fast turnovers in private practice hospitals too. Bottom line, I don't think this machine wrapper is a great idea. Common sense with changing dirty gloves and a good wipe down between cases seems to be enough, considering the carts the patients actually lay on receive lesser treatment in between uses.


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nimbus said:
I said intuitively because logically it doesn't make sense for the reasons I described above.
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At my shop its the only place that seems to look the other way in regards to cloth surgeon caps. I have 4 different ones, and its nice to get to wear them. If I have to put a bouffant over it anyway, it seems silly to wear both. I think its a silly rule. Sure, it may reduce infections by preventing my hair from shedding into a possible sterile field. But most female anesthetists I work with, wearing the bouffant caps, their hair sticks it quite severely.

For clipboarders and surgeons, its just always easier to reach for anything or anyone else to blame.
 
GasPackerGB said:
Lots wrong with that machine condom. For example, Say you're bagging patient and your bag pops off and falls to floor. When you try to put the bag back on, the plastic machine condom gets caught between the the opening of the bag and the arm of the circuit, occluding flow into and out of the bag. Messing around with that nonsense on induction or if patient is in laryngospasm, etc isn't something I'm interested in. One of the hospitals I'm at has touch screen monitors, will the bag interfere with that?

I routinely wipe the machine surfaces, vaporizors, fresh gas flow knobs, cart surfaces etc off even if I have a tech I know is doing it too. I change a sterile towel to put my airway equipment on between every case. It takes 1-2 minutes. Pretty fast turnovers in private practice hospitals too. Bottom line, I don't think this machine wrapper is a great idea. Common sense with changing dirty gloves and a good wipe down between cases seems to be enough, considering the carts the patients actually lay on receive lesser treatment in between uses.


Sent from my iPhone using SDN mobile
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I mean, if it does get passed as a policy at an institution, it's going to be passed b/c it is the 'best for the patient'. I dont think they'll care much about the issues the anesthesiologists will have to deal with..
 
anbuitachi said:
I mean, if it does get passed as a policy at an institution, it's going to be passed b/c it is the 'best for the patient'. I dont think they'll care much about the issues the anesthesiologists will have to deal with..
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I'm not saying that hospital admin, clipboarders, JCAHO, and the like will care. They'll do whatever they want, which in their eyes is "best for the patient". But these measures, no matter how well-meaning the intent, often make the patients less safe. That is what we see in direct patient care. We will have to follow whatever policy is dictated. I was just pointing out a few issues that may impede patient care with the machine cover.


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I think reasonable people can make reasonable arguments against this thing.

Your bag falling on the floor in the middle of a laryngospasm episode and plastic somehow then getting stuck in there when you put the bag back on, resulting in a can't ventilate situation? That's not a reasonable argument. That's just ludicrous.

Touchscreens work fine through the cover.
 
I wouldn't use that single circumstance as an argument against the plastic cover. My overall feeling (having never used one during a case) is that the cover could be cumbersome and could slow me down. The bag getting caught up in the plastic was just something that first popped into my mind as I wrote that post during a long case. My bag wasn't secured well to the arm of the machine and came off when I was masking the patient on induction. No big deal in that instance. If a big billowy piece of plastic was covering my entire machine and circuit then it might have slowed me down. Same could be for a circuit disconnect at the machine. Unlikely? Sure. Even more unlikely that it would cause patient harm. But I wouldn't say it's ludicrous, nor am I unreasonable. It is unreasonable to not be skeptical of a new piece of equipment and how it may impact how you do a case. If/when something like this gets implemented at one of my hospitals I'll use it. Maybe it will be a success and my concerns will be proven wrong. But I won't know until I use it many times and neither will you.




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This was surprisingly talked about during grand rounds w research showing decreased contamination w this . I won't be surprised if this becomes reality in a few years
 
waterbottle10 said:
This was surprisingly talked about during grand rounds w research showing decreased contamination w this . I won't be surprised if this becomes reality in a few years
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The entire world is contaminated. Contamination does not equal infection. Using this logic, every piece of equipment in the OR should be covered and everybody in the operating room should be covered in a spacesuit.
 
nimbus said:
The entire world is contaminated. Contamination does not equal infection. Using this logic, every piece of equipment in the OR should be covered and everybody in the operating room should be covered in a spacesuit.
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Yep and its coming. I see it. In a few years everything will be covered. I bet you those companies will push for it, do studies for it, show that it decreases contamination, and make the correlation to infection, and then someone will sue someone for not using it, and the lawyers will make some bull**** argument to win over the jury, and then hospitals will all mandate it
 
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anbuitachi said:
Yep and its coming. I see it. In a few years everything will be covered. I bet you those companies will push for it, do studies for it, show that it decreases contamination, and make the correlation to infection, and then someone will sue someone for not using it, and the lawyers will make some bull**** argument to win over the jury, and then hospitals will all mandate it
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Or once another company tests those covers and realizes the covers are colonized with bacteria they will invent a cover for the cover...and charge double.

The funny thing is that humans keep trying to outsmart bacteria, but bacteria keep winning. A very famous scientist once said "life finds a way."
 
dr doze said:
Just look at the way many practitioners actually practice. Wear gloves. Stick fingers of right hand in the mouth to open. Grab laryngoscope handle that may or may not be on sterile towel on anesthesia machine with dirty right hand. Transfer laryngoscope to left hand. Use right hand to adjust laryngeal view. Ask assistant who may or may not be gloved to apply pressure on now dirty neck. Intubate. Place laryngoscope, now dirty on cart. Maybe on towel. Maybe not. Squeeze bag with dirty right hand. use dirty right hand to flip switch to vent. Use dirty right hand to adjust vaporizer input, ventilator settings, maybe on touch screen if new machine maybe not. Maybe need different size airway or different blade, use dirty right hand hand to open drawer to cart. Touch inside of drawer. I am sure that there is absolute first rate in "wiping down" anesthesia machine and cart and drawers between cases everywhere.😉. Is it really so hard to imagine that just maybe anesthesia care is responsible for at least some infections?
Click to expand...
I rarely stick my fingers in someone's mouth when intubating. I never handle the laryngoscope with my dirty or clean right hand. Always my left. I never bag with gloves on. They immediately get thrown away after intubation. When I place an LMA is when I stick my hands in someone's mouth. Either way, I throw away the gloves immediately and then inflate the balloon and bag the patient.

All the above sounds so gross.
I am a little neurotic about germs though.
 
facted said:
Either put covers on shoes or they have to be OR dedicated.
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This has always irked me, particularly during inspections when you would get dinged for not removing shoe covers when leaving the OR and vice versa. Following this logic, should we no stop the patient at the magic red line and transfer to a gurney whose wheels haven't been on the other side? What about the equipment that they bring in from outside the OR (C-arms, portable scope set ups, etc?). All of these things have just been rolling/touching the same floor that my (supposedly) now grossly contaminated shoes have been in contact with yet no one seems to think that there is a problem.
 
Neogenesis said:
This has always irked me, particularly during inspections when you would get dinged for not removing shoe covers when leaving the OR and vice versa. Following this logic, should we no stop the patient at the magic red line and transfer to a gurney whose wheels haven't been on the other side? What about the equipment that they bring in from outside the OR (C-arms, portable scope set ups, etc?). All of these things have just been rolling/touching the same floor that my (supposedly) now grossly contaminated shoes have been in contact with yet no one seems to think that there is a problem.
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Don't give the clipboard nurses any ideas or else we'll be putting on little plastic bootie covers for the equipment wheels
 
Neogenesis said:
This has always irked me, particularly during inspections when you would get dinged for not removing shoe covers when leaving the OR and vice versa. Following this logic, should we no stop the patient at the magic red line and transfer to a gurney whose wheels haven't been on the other side? What about the equipment that they bring in from outside the OR (C-arms, portable scope set ups, etc?). All of these things have just been rolling/touching the same floor that my (supposedly) now grossly contaminated shoes have been in contact with yet no one seems to think that there is a problem.
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You can bet those wheels are never cleaned in decades rolling over vomit, s***, MRSA, VRE, MDR TB, etc....
 
chocomorsel said:
I rarely stick my fingers in someone's mouth when intubating.
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This is a skill I picked up as an attending. I heard about it in residency but wasn't able to attempt it because everyone wanted residents to stick their hands in the mouth and scissor open before intubating to "get a better view." (But it's understandable and I don't blame them, I tell all my med students to scissor open so they have a better chance of successful intubation.) Nowadays I can't remember the last time I had to stick fingers in to open the mouth. With LMA, rarely do I need to either, but if so I use a tongue depressor.
 
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