Vital Times 2017 - 62

Increase in Mortality
Contaminated Stopcock

Odds Ratio

95% Confidence Interval

P-Value

Site	0®

0.01

.000-.389

0.014

Site	2®

0.00

.000-.425

0.021	

ASA

74.1

4.94-1112.15

0.002	

Contaminated	Stopcock

58.5

2.32-1477.02	

0.014

Anes Analgesia 2012 Jun;114(6):1236-48

and shoe covers, and evidence-based practices. Do you
know what truly matters? Hand washing, antibiotics,
site preparation, and the OR environment. And hand
washing. We all have the same goal: Prevention of SSIs
and recommendations that are evidenced based. But
for any issue, the longer the list of related items, the less
importance attributed to each item. (This is the same
problem long checklists have...) The fact is that our
SSI list is long and contains items that are not evidence
supported.2
What role do anesthesiologists play in this? Hand
washing. Cleaning your workstation. Did I mention hand
washing? One thing you can do easily is to have a simple
tray next to the patient where you can deposit your used
laryngoscope and dirty gloves after airway manipulation,
before turning back to the anesthesia machine to give
a breath or turn on a vaporizer. Check yourself the
next time you intubate and see where your hands go
immediately after that, gloved or not? See how easy it is
to transfer pathogens? Where are your hand sanitizers?
Are they empty? How often do you use them?
The slide that pushed me over the edge was in a talk by
Randy Loftus, MD, who showed us soon to be published
data where: 1) he took cultures from various places in the
OR and 2) identified precisely which strain of bacteria
was present at these sites. He then followed those specific
bacterial strains for the day. He had one example where
bacteria from the OR nursing desk showed up on the
anesthesia tubing stopcock for the TO-FOLLOW

62 		|	 	 CSA	Vital	Times

PATIENT! Yes, the 7:30 AM nursing station bacteria
found its way to your noon patient's stopcock. And it was
MRSA. Wash your hands.
And it was not just a few bacteria. Over 50,000 CFUs
(colony forming units) were waiting to be injected
into your unsuspecting patient. I had to look at the
recorded version of the lecture because I thought I had
heard it wrong when I left the live session. I had it right.
Wash your hands. Clean your anesthesia machine, the
vaporizers, the computer and the Pyxis. All the places
you touch all the time.
Does a contaminated stopcock make a difference? Oh
yes. And how long does it take an open stopcock to
become contaminated? 4 minutes. Loftus examined the
prior association of stopcock contamination with 30-day
postoperative infection and mortality. Look at this table;
odds ratio of 58!
So now what? What do I do about my knee and the
anesthesiologists wherever I go for surgery? Do I
insist they "scrub the hub" of the stopcock with readily
available stopcock disinfecting devices before each
injection of the many medications I will need? Do I insist
they wash their hands at least five times per hour? Do
I insist they place disinfecting devices on the syringes
tips they are using? Do I insist they disinfect their
workstation, the Pyxis, the anesthesia machine prior to
my coming into the room? YOU BET I DO!



Table of Contents for the Digital Edition of Vital Times 2017

Vital Times 2017 - Cover1
Vital Times 2017 - Cover2
Vital Times 2017 - 1
Vital Times 2017 - 2
Vital Times 2017 - 3
Vital Times 2017 - 4
Vital Times 2017 - 5
Vital Times 2017 - 6
Vital Times 2017 - 7
Vital Times 2017 - 8
Vital Times 2017 - 9
Vital Times 2017 - 10
Vital Times 2017 - 11
Vital Times 2017 - 12
Vital Times 2017 - 13
Vital Times 2017 - 14
Vital Times 2017 - 15
Vital Times 2017 - 16
Vital Times 2017 - 17
Vital Times 2017 - 18
Vital Times 2017 - 19
Vital Times 2017 - 20
Vital Times 2017 - 21
Vital Times 2017 - 22
Vital Times 2017 - 23
Vital Times 2017 - 24
Vital Times 2017 - 25
Vital Times 2017 - 26
Vital Times 2017 - 27
Vital Times 2017 - 28
Vital Times 2017 - 29
Vital Times 2017 - 30
Vital Times 2017 - 31
Vital Times 2017 - 32
Vital Times 2017 - 33
Vital Times 2017 - 34
Vital Times 2017 - 35
Vital Times 2017 - 36
Vital Times 2017 - 37
Vital Times 2017 - 38
Vital Times 2017 - 39
Vital Times 2017 - 40
Vital Times 2017 - 41
Vital Times 2017 - 42
Vital Times 2017 - 43
Vital Times 2017 - 44
Vital Times 2017 - 45
Vital Times 2017 - 46
Vital Times 2017 - 47
Vital Times 2017 - 48
Vital Times 2017 - 49
Vital Times 2017 - 50
Vital Times 2017 - 51
Vital Times 2017 - 52
Vital Times 2017 - 53
Vital Times 2017 - 54
Vital Times 2017 - 55
Vital Times 2017 - 56
Vital Times 2017 - 57
Vital Times 2017 - 58
Vital Times 2017 - 59
Vital Times 2017 - 60
Vital Times 2017 - 61
Vital Times 2017 - 62
Vital Times 2017 - 63
Vital Times 2017 - 64
Vital Times 2017 - 65
Vital Times 2017 - 66
Vital Times 2017 - 67
Vital Times 2017 - 68
Vital Times 2017 - 69
Vital Times 2017 - 70
Vital Times 2017 - 71
Vital Times 2017 - 72
Vital Times 2017 - 73
Vital Times 2017 - 74
Vital Times 2017 - 75
Vital Times 2017 - 76
Vital Times 2017 - 77
Vital Times 2017 - 78
Vital Times 2017 - 79
Vital Times 2017 - 80
Vital Times 2017 - 81
Vital Times 2017 - 82
Vital Times 2017 - 83
Vital Times 2017 - 84
Vital Times 2017 - 85
Vital Times 2017 - 86
Vital Times 2017 - 87
Vital Times 2017 - 88
Vital Times 2017 - Cover3
Vital Times 2017 - Cover4
https://www.nxtbook.com/allen/csvt/vital-times-2021
https://www.nxtbook.com/allen/csvt/2020
https://www.nxtbook.com/allen/csvt/2019
https://www.nxtbook.com/allen/csvt/2018
https://www.nxtbook.com/allen/csvt/2017
https://www.nxtbook.com/allen/csvt/2016
https://www.nxtbook.com/allen/csvt/2015
https://www.nxtbook.com/allen/csvt/2014
https://www.nxtbookmedia.com