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Anesthesia Infection in the Operating Room Anesthesia Work Area

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➤ The anesthesia supply cart should have its accessible outer surfaces wiped clean between cases. To prevent contamination of communal supplies, anesthesia providers should always perform HH before opening the drawers or bins of the cart and handling the contents of the drawers or bins. Storage of supplies on the top surface of the cart should be avoided as much as possible and any supply items on the cart top surface should be removed between cases to facilitate cleaning. The interior of the supply cart should be cleaned on a periodic basis. Future innovation and re-engineering of the storage, dispensing, and restocking of supplies in the anesthesia work area is needed to decrease the potential for bacterial cross contamination between cases. ➤ Provider-prepared sterile injectable drugs (eg, a drug drawn from a vial into a syringe) are more likely to be subject to contamination than drugs prepared in an International Organization for Standardization (ISO) Class 5 setting, such as a pharmacy. Therefore, provider-prepared sterile injectable drugs should be used as soon as practicable following preparation. The package inserts for propofol that contain a preservative typically specify that the use of propofol should commence within 12 hours of preparation. At the time of this publication, United States Pharmacopeia (USP) Chapter recommends that the use of provider- prepared sterile injectable drugs commence within 1 hour of preparation. However, a draft revision of USP General Chapter suggests that a drug from a single dose vial punctured or entered in environments with air less clean than ISO class 5 may be used until the end of a case. If available, commercially prefilled syringes or syringes prepared by the hospital pharmacy in an ISO class 5 setting have a relatively long "beyond use date." ➤ Anesthesia practitioners should minimize the time between spiking IV bags and patient administration. Nevertheless, certain emergent or urgent circumstances may require advanced set-up of IV fluids, and anesthesia providers should comply with their hospital protocols. Following spiking of an IV bag, administration should commence as soon as possible. No specific time limit has been identified in the literature for advance preparation of IV bags. ➤ Single-dose medication vials and flushes should be used whenever possible. If multiple-dose medication vials must be used, they should be used for only 1 patient and should be accessed only with a new sterile syringe and new sterile needle for each entry. Syringes and needles are single patient devices and syringes should never be reused for another patient, even if the needle is changed.

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