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Oh please.
The fact that some of us have to wear those absurd disposable jackets in the OR is bad enough
Probably yet another $50 expense per case that will start in academia, then filter down to hospital ORs, then when surgery centers are required to use it they will go out of business. Excessive costs are straining the budgets of many centers now, including the fact that one vial of ephedrine that costs 5 cents to manufacture, is sold at $76 per vial. The cumulative costs of out of control prices for drugs and equipment is causing cost escalations to patients. It is speculative that the anesthesia machine harboring bacteria causes transmission to patients although with respect to suction it is certainly a concern.
Thats an expensive ephedrine vial... it's not that expensive at my institution
Funny.I have never heard of one case of infection caused by anesthesia machines!
This is just someone trying to capitalize on the enormous disposable/consumable market in medicine. Fear monger about the infection rates and every administrator will be jumping to buy them and every clipboard warrior will be checking to make sure your machine is properly covered and not an inch of skin is exposed. Then the patient will go to the floor and you'll check on them post-op day 1 and they'll be lying in a sweaty, smelly bed with dirty scrambled eggs in the sheets from the morning breakfast 6 hours ago. The entire unit will smell like stale pee, but yeah, it's the 1/4 inch of exposed ear lobe of the anesthesiologist that is responsible for the infection.
My old pharmacy didn't question when we split ketamine between patients (each got their own stick drawn up in proper fashion, don't freak out, purists). I told them once if they ever had concerns, then supply us with 100mg vials in our drug boxes.like how each vial of medication can only be used for 1 patient.. ive actually never finished a vial of 500mg ketamine on 1 patient in the OR
Re: ephedrine- we checked three different suppliers and $76 per vial was the lowest obtainable by the surgery center. We called two manufacturers and were met with stunned silence when we told them what McKesson and others were charging, then they made the statement there had been a price hike but the cost should not be that high. Yet, the manufacturers we contacted have entered into an agreement with the government to not sell ephedrine directly to surgery centers or offices (ostensibly because of manufacture of illicit drugs). At these prices it wouldn't surprise me if some mid level or upper level surgery center administrator goes postal and starts taking out the greedy SOBs that are hiking the prices so much.
It's a fairly recent price hike. Check again.
A giant condom for the anesthesia machine? What about IV poles, electrocautery machines, infusion pumps, tourniquet boxes, bair huggers, etc? Shouldn't we be wrapping that s*** up? Why aren't we gowned up in space suits?
That is the slippery slope this heads toward.
Any infection control practices ultimately ignore the facts that you have to touch the patient and skin flora exist.
The objection I have is to cost and to the fact that such barriers have not proven to alter outcome. Do the studies, then sell the product. It may also be just as efficacious to spray the work surface with chlorhexidine as a spray at the end of each case. (CDC - Disinfection & Sterilization Guideline:Disinfection - HICPAC)
FURTHERMORE: once you go down that road, then you can no longer have blood pressure cuffs or pulse oximeters that are multiple use. You cannot have the ECG leads, blood pressure tubing, or pulse oximeter cable touching the next patient without disinfecting them between cases. The stool or chair you use would have to be disinfected between cases. Rolls of tape used by anesthesiology would have to become single use since the outside of the roll is potentially contaminated if touched. Temp strips would have to be packaged individually. Laryngoscopes would all have to be single use. Is this really where you want to go???
No, that is not how it is in most places. I work in 10 surgery centers and 3 hospitals. All but one reuses laryngoscope handles and blades. Temp probes are single use but temp strips are not packaged individually, therefore subject to contamination. Tape is used from case to case to case- the rolls are discarded only after the supply on the roll is exhausted. Monitors are wiped in some - never. In some it is once a day. None of them wipe the monitors down nor the components of the machine between cases. Only one uses disposable blood pressure cuffs, and reuses some of those. None of them use disposable pulse oximeter probes. None of them routinely wipe down cables, cords, or tubing between every case. None of them routinely wipe down the anesthesia tubing tree. Some use multiuse tubes of gel lubricant for ETT and LMAs. What I am saying is it is illogical to protect the work surface without addressing all the other commonly present potential contamination areas.
It's a Giant Condom for the machine/equipment.
The objection I have is to cost and to the fact that such barriers have not proven to alter outcome. Do the studies, then sell the product. It may also be just as efficacious to spray the work surface with chlorhexidine as a spray at the end of each case. (CDC - Disinfection & Sterilization Guideline:Disinfection - HICPAC)
FURTHERMORE: once you go down that road, then you can no longer have blood pressure cuffs or pulse oximeters that are multiple use. You cannot have the ECG leads, blood pressure tubing, or pulse oximeter cable touching the next patient without disinfecting them between cases. The stool or chair you use would have to be disinfected between cases. Rolls of tape used by anesthesiology would have to become single use since the outside of the roll is potentially contaminated if touched. Temp strips would have to be packaged individually. Laryngoscopes would all have to be single use. Is this really where you want to go???
It's a Giant Condom for the machine/equipment.
My hospital approached us about pretty much all of these things. My reply was show me some data. Some of the clipboard nurses are really on another level.
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Il Destriero
How do I get into the bottom drawers with that thing on? Will I need to shower and change scrubs between cases?
I have never heard of one case of infection caused by anesthesia machines!
Is it okay to wear home laundered cloth caps if they are covered by a disposable cap?
“We have surgical team members in our facility that wear reusable cloth caps. The caps are not washed in a health care-accredited laundry. Our director has asked these team members to put a disposable cap over the cloth cap. Is this okay?”
Yes. A reusable cloth cap that is contained within a disposable cap may be home laundered, just as other personal clothing (e.g.,T-shirts) contained within the scrub attire are home laundered.
Resources:
Updated November 13, 2014.
- Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
Surgical Attire - Association of periOperative Registered Nurses
The majority of these guidelines come from nursing guidelines and have zero evidence behind them. We've been told by NY DOH that we can't have Tshirts under our scrubs. It's utterly ridiculous. I'm glad they let me wear underwear and socks.
Either put covers on shoes or they have to be OR dedicated.Do you have to change into special OR shoes?
Again, I draw a distinction between outpatient cases at an asc or hospital surgery center and cases on inpatients with known infections.
The latter patients are a big deal. Yes, I think everything on these folks should be single use. Yes, I think you need to take off your gloves and be clean before getting into your cart. Yes, I think you need to throw away the tape roll after you use it- on these patients.
I hear you on the environmental concerns. I really do. But think of all the single use crap that'll be necessary if the next patient gets an infection that keeps them in house for days or weeks longer.
Again, open the April 2015 A&A. We can pretend this isn't an issue, but it is. I have completely changed the way I physically interact with the anesthesia workspace because of it.
If you could thoroughly clean the workspace between cases, that'd be one thing- but you can't do that and turn the cases over in any way approaching efficient.
As a rule of thumb, pretend that your inpatient has a layer of **** covering them, and act accordingly. Because they do.
Oh, and stop dragging your open stopcocks all over the patient's nasty bed, and stop injecting into luer ports that have been laying on the bed without cleaning them too.