New Guidance Outlines Recommendations for Infection Control in Anesthesiology

Press Release: The Society for Healthcare Epidemiology of America, December 2018.

Arlington, Va. — The Society for Healthcare Epidemiology of America has issued new expert guidance on how hospitals and healthcare providers may reduce infections associated with anesthesiology procedures and equipment in the operating room. The guidance, published in SHEA’s journal, Infection Control & Healthcare Epidemiology, recommends steps to improve infection prevention through increased hand hygiene, environmental disinfection, and continuous improvement plans.

“Even though the demands on anesthesia providers make infection prevention best practices more challenging, there are opportunities for improvement,” said Silvia Munoz-Price, MD, PhD, lead author of the guidance and Professor of Medicine at Froedtert & Medical College of Wisconsin. “We describe how the anesthesiology team and hospital leaders can optimize infection prevention in operating room anesthesia, and we give suggestions for the future, including the need for better equipment design.”

A growing body of research has shown that contamination in anesthesiology work areas is connected to healthcare-associated infections that put patients at risk. A survey of 49 U.S. and international facilities showed infection control policies and practices are inconsistent. A writing panel—consisting of representatives from SHEA, the American Association of Nurse Anesthetists (AANA), the Anesthesia Patient Safety Foundation (APSF), and the American Society of Anesthesiologists (ASA)—developed the guidance to establish procedures and best practices specific to anesthesia in the operating room

“Following these evidence-based guidelines will assist in reducing contamination in operating room anesthesia,” said Marjorie Geisz-Everson, PhD, CRNA, APRN, FNAP. “Collaboration between the anesthesia and infection prevention communities has resulted in a comprehensive model that includes best practices in lowering infections for hospital leaders and providers to implement. In addition, assessing current infection prevention practices will aid in decreasing infections that occur during procedures and equipment used in the operating room.”

The key recommendations include:

  • Hand hygiene should be performed, at a minimum, before aseptic tasks, after removing gloves, when hands are soiled, before touching the anesthesia cart, and upon room entry and exit. The authors also suggest strategic placement of alcohol-based hand sanitizer dispensers.
  • During airway management, the authors suggest the use of double gloves so one layer can be removed when contamination is likely and the procedure moves too quickly to perform hand hygiene. The report also recommends high-level disinfection of reusable laryngoscope handles or adoption of single-use laryngoscopes.
  • For environmental disinfection, the guidance recommends disinfecting high-touch surfaces on the anesthesia machines, as well as keyboards, monitors and other items in work areas in between surgeries, while also exploring the use of disposable covers and re-engineering of the work surfaces to facilitate quick decontamination in what is often a short window of time.
  • IV drug injection recommendations include using syringes and vials for only one patient; and that injection ports and vial stoppers should only be accessed after disinfection.
    The authors suggest that implementation of the recommendations requires multi-level collaboration within the hospital, regular monitoring, and evaluation of infection prevention practices with regular feedback for providers as well as clarity in expectations about behaviors. According to the guidance, leadership should define goals, remove barriers to infection prevention, and empower practitioners to meet standards.

The guidance was endorsed by the SHEA Board of Trustees, AANA, the Association for periOperative Registered Nurses (AORN), APSF, and the American Academy of Anesthesiologist Assistants (AAAA), with a letter of support from ASA.


Silvia Munoz-Price, Andrew Bowdle, B. Lynn Johnston, Gonzalo M. Bearman, Bernard C. Camins, E. Patchen Dellinger, Marjorie A. Geisz-Everson, Galit Holzmann-Pazgal, Rekha Murthy, David Pegues, Richard C. Prielipp, Zachary A. Rubin, Joshua Schaffzin, Deborah Yokoe, David J. Birnbach. “SHEA Expert Guidance: Infection Prevention in the Operating Room Anesthesia Work Area.”

About ICHE
Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 19th out of 83 Infectious Disease Journals in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.

Society for Healthcare Epidemiology of America (SHEA) is a professional society representing more than 3,000 physicians and other healthcare professionals around the world who possess expertise and passion for healthcare epidemiology, infection prevention, and antimicrobial stewardship. The society’s work improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers, hospitals, and health systems. This is accomplished by leading research studies, translating research into clinical practice, developing evidence-based policies, optimizing antibiotic stewardship, and advancing the field of healthcare epidemiology. SHEA and its members strive to improve patient outcomes and create a safer, healthier future for all. Visit SHEA online at

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How Can We Reduce and Avoid Opioids from Widespread Abuse?

In the past two years, there has been a vast increase in documented cases of misuse of prescription drugs. While stimulants used to treat attention-deficit hyperactivity disorder (ADHD) and central nervous system (CNS) depressants used to treat anxiety continue to be abused, nothing compares to the misuse of opioids, which is leading to a nationwide epidemic. According to the Department of Health and Human Services, opioid overdoses accounted for more than 42,000 deaths in 2016.

While prescription opioids are used to treat moderate to severe pain in both surgical and non-surgical patients, these medications are abused for various non-medical reasons. These include: relieving tension, curiosity/experimentation, getting “high”, countering the effects of other drugs, and help with sleep. Individuals who consume opiates over an extended period of time can develop a tolerance, requiring them to take more of these drugs to elicit the same effect. This can lead to addiction and increase the risk of overdose and death.

Hospitals and healthcare providers are now taking a new approach to tackle opioid abuse. Fewer opioid medications are being prescribed, in favor of other non opioid medications, such as Tylenol, Motrin and gabapentin. Patients undergoing surgical procedures are now being prepared for realistic expectations of post surgical pain. Some institutions are even taking a multidisciplinary approach to combating prescription opioids, encompassing the assistance of psychologists to help patients deal with the impact of pain. Learning how to safely dispose of opioids and pain medication is also important.

As Certified Registered Nurse Anesthetists and Anesthesiologists, what can we do to stop this increasing epidemic of opioid abuse? Some options include non-opioid medications, ultrasound-guided peripheral nerve blocks, and patient education. It’s also important for us to stay educated on new procedures and trends that can improve the lives of our patients, now and in the future.


ERAS: A Path to Avoid Opioids

Enhanced Recovery After Surgery: A Path to Avoid Opioids

In an opioid-driven world, what are other options to help patients after surgery and spare them from touching opioids? Enhanced Recovery After Surgery (ERAS) is one method. ERAS utilizes non-opioid medications and techniques to control pain, shorten recovery period or length of stay in a hospital, and decrease complication rates after surgery. Here’s what you need to know about Enhanced Recovery After Surgery (ERAS).

What is ERAS?

ERAS is a patient-centered, evidence-based, pain management strategy employed by CRNAs anesthesia providers to avoid the need for opioids and improve patient outcomes. ERAS uses robust patient communication and opioid-sparing techniques such as regional anesthesia, peripheral nerve blocks, non-pharmacologic approaches, and non-opioid medications. While a traditional pain management pathway includes patient assessment followed by opioid/non-opioid prescribing and discharge, ERAS follows a much more effective path.

ERAS Pain Management Pathway

  1. Preadmission – patient/family education; recovery and pain management planning
  2. Preoperative – minimize fasting to reduce anxiety and pain perception and improve diet recovery
  3. Intraoperative – administer analgesics and nerve blocks for pain and nausea/vomiting management
  4. Postoperative – patient assessment, plan medication, and multimodal medication prescribing
  5. Post-Discharge – education on anesthesia recovery, surgical procedure, and pain management
  6. Continued Quality Improvement – analysis of compliance and outcomes to improve care

The Advantages of ERAS

Research has consistently shown that adoption of enhanced recovery (ER) leads to significant improvements in patient satisfaction, outcomes, and reduction in cost of care. To successfully integrate ER into practice, a structured, collaborative, multidisciplinary approach accompanied by education and awareness campaigns can be valuable. According to the Future of Anesthesia Care Today, ERAS improves the following outcomes:

  • ERAS provides an average savings of $880 to $5,560 per patient.
  • ERAS reduces patient length of stay by 3-4 days on average.
  • ERAS reduces 30-day patient readmission rates and costs.
  • ERAS helps patients return to normal activities more quickly.

To learn more about Enhanced Recovery After Surgery (ERAS), please contact us.


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