Section: UTMB On-line Documentation Subject: Healthcare Epidemiology Policies and Procedures Topic: Anesthesiology

2.1 - Policy 04.08.08 - Revised 1978 - Author

2.1 Anesthesiology

Purpose	To outline guidelines for safe practices in the Department of Anesthesiology
Audience	All employees of UTMB hospitals and clinics, contract workers, volunteers, and students in the Department of Anesthesiology/Operating Room Support Services
Policy Personnel	• Handwashing shall be performed before and after each patient contact (see policy: 1.14 Hand Hygiene for All Hospital Employees). • Personnel shall comply with Employee Health Center guidelines for their area. • Eating and drinking shall be confined to designated areas. • All personnel shall adhere to the hospital dress code and to the dress code of their department. Clean attire shall be worn at all times. • All personnel shall follow the instructions as posted on the door of a patient in isolation. All guidelines shall be followed. Items which shall be removed from the patient’s room shall not be placed on surfaces in that room (see policy: 1.19 Isolation). • Suspected or known exposure to or acquisition of a communicable disease shall be reported to the Department of Healthcare Epidemiology or the Employee Health Center immediately. • Cuts and lacerations shall be covered with a waterproof dressing. • The Standard Precautions policy shall be followed for any and all contact with blood and body fluids.
Equipment and Supplies	• Disposable devices shall be discarded after one use unless approved for inclusion in the UTMB program for reprocessing of single use devices (see policy: 1.07 Disposable Patient Care Items). • Clean equipment shall be covered with plastic for storage. • Anesthesia carts shall be cleaned and disinfected after every case. Emergency equipment such as resuscitation bags and laryngoscope blades shall not be left on anesthesia carts unless protected by appropriate dust covers. • Any reusable instrument in direct contact with mucous membranes shall receive at least high level disinfection prior to reuse (such as laryngoscope blades). • Soda lime canisters do not need to be routinely changed. The canister shall be replaced when the indicator dye changes color indicating gradual exhaustion. • Anesthesia personnel are strongly encouraged to receive the influenza vaccine annually. • Anesthesia personnel with cutaneous infections of the hands or forearms or facial infections not covered by occlusive dressings shall not enter the operating room or handle equipment. - Personnel with such symptoms shall report their illness to their supervisor. - The employee will be sent to the Employee Health Center for evaluation to determine whether the employee must be sent home or can return to work. • Separate clean and dirty work areas shall be defined and maintained. • Used laryngoscope blades and any other non-disposable equipment that comes in contact with patients’ mucous membranes shall be separated from sterile supplies and disinfected between patients (see policy: 1.05 Cleaning and Reprocessing of Patient Care Equipment and Medical Devices). • All clean and sterile supplies shall be stored on shelves or pallets at least 8”-10” off the floor. Clean and sterile supplies shall be dust-free. Clean and dirty supplies shall always be segregated. • Gloves shall be worn when cleaning items contaminated with patients’ blood, other body fluids or excretions. Handwashing shall always be performed after removal of gloves. • All refrigerators shall contain thermometers and the temperature recorded daily (see policy: 1.04 Care of Refrigerators and Freezers). • All disposable single use items shall be used once and then discarded unless approved for inclusion in the UTMB program for reprocessing of single use devices. All equipment contaminated with blood or other body fluids shall be decontaminated by appropriate means prior to being reprocessed or serviced (i.e., in the decontamination room). • When equipment cannot be decontaminated prior to servicing or reprocessing a sticker displaying the biohazard symbol shall be attached to the equipment. The area(s) contaminated shall be written on the front of the sticker. • The following equipment shall be sterile: vascular needles, catheters and tubing, syringes, stopcocks, regional block needles and catheters, and urinary catheters. • The following equipment shall be reprocessed by at least high-level disinfection between uses: laryngoscope blades, Magill forceps and temperature probes. • The following equipment is considered non-critical and shall be cleaned with a detergent/disinfectant between uses: blood pressure cuffs, electrocardiograph cables, pulse oximeter cables, skin temperature sensor cables, stethoscopes, blood warmers and infusion pumps. The exterior surfaces of anesthesia machines shall be cleaned daily. • All anesthesia supplies shall be checked weekly for expiration dates. Outdated non-disposable packs shall be returned to Sterile Processing.
Medications	• Medications shall not be set up longer than 24 hours in advance of use. • Medications shall be supplied in single dose vials when possible. If multi-dose vials of medications are used, they shall be dated when opened and discarded according to Pharmacy policy (See Policy 2.22 Pharmacy). Irrigation bottles of saline and water shall be dated and discarded every 24 hours. • Medication drawn up in a syringe shall not be administered to more than one patient. The syringe is considered contaminated after it has been used to enter a vascular line. The syringe must be discarded once contaminated. • Medication dispensed for one case and not used may be used for the next case provided it has not been contaminated and was drawn up less than 24 hours ago. • Stopcocks, multi-dose vials, infusion ports on intravascular lines, and other portals of access to sterile fluids shall be handled with aseptic technique by wiping the septum with alcohol before each puncture, and always using a sterile needle to enter the system. • Propofol must be drawn into a sterile syringe immediately after the ampule is opened and administration shall commence promptly. Each unit of propofol is intended for use in a single patient and the syringe and unused portion shall be discarded at the end of the surgical procedure. • Tubing used to administer propofol must be changed every 6 or 12 hours, depending on its use, per manufacturer’s recommendation. • Whenever possible, needles shall not be removed from syringes. They shall be discarded as a unit. Mechanical devices shall be used to remove any needles that must be removed from the syringe. • Use fluid containers and administration sets (tubing, connectors) for a single patient only. This includes disposable pressure transducers and tubing and other items that contact the vascular system or other sterile body fluids. • Discard multi-dose containers if contaminated or if contamination is suspected. Use unit dose packages whenever possible.
Procedures	• Anesthesiology staff will not set up the “Hot line” in advance of cases. • The arterial line/central venous pressure line will be set up for no longer than 24 hours. The lines will be labeled with date and time at assembly. After this time, the fluid and tubing will be discarded. • The intravenous set up for peripheral IVs will be assembled and placed in the warmer for no longer than 24 hours. The assembly will be labeled with date and time when setup. The IV set up will be placed in a bag to prevent inadvertent touch contamination. After 24 hours, the tubing and fluids must be discarded. • Subarachnoid and epidural neural blockades must be done under strict aseptic technique, using a surgical mask, sterile gloves, sterile drape, and sterile prep with chlorhexidine gluconate. - Wear a surgical mask when injecting material into the spinal canal or subarachnoid space for spinal or epidural anesthesia. - The infusion line and solution should be changed every 96 hours. - The infusion system should not be entered except for changing the line and solution at 96 hours. • For placement of intravascular devices, see policy: 1.18 Intravascular Devices and Infusion Systems.
References	1. Herwaldt LA, Pottinger JM, Coffin SA, Schulz-Stübner S. Nosocomial infections associated with anesthesia. In: Mayhall CG, ed. Hospital Epidemiology and Infection Control. Philadelphia: Lippincott Williams and Wilkins 2004:1073-1115. 2. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR 2002; 51(No. RR-10):1-33. 3. Brooks K, Pasero C, Hubbard L, Coghlan RH. The risk of infection associated with epidural analgesia. Infect Control Hosp Epidemiol 1995; 16:725-726. 4. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. June 2007. http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf