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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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27.02.2024 | Reports of Original Investigations

A threshold of 100 or more colony-forming units on the anesthesia machine predicts bacterial pathogen detection: a retrospective laboratory-based analysis

verfasst von: Franklin Dexter, MD, PhD, FASA, Kaitlin M. Walker, Carmen Troncoso Brindeiro, PhD, Chase P. Loftus, Cornelie C. L. Banguid, MPH, Randy W. Loftus, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 5/2024

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Abstract

Purpose

Preventing the spread of pathogens in the anesthesia work area reduces surgical site infections. Improved cleaning reduces the percentage of anesthesia machine samples with ≥ 100 colony-forming units (CFU) per surface area sampled. Targeting a threshold of < 100 CFU when cleaning anesthesia machines may be associated with a lower prevalence of bacterial pathogens. We hypothesized that anesthesia work area reservoir samples returning < 100 CFU would have a low (< 5%) prevalence of pathogens.

Methods

In this retrospective cohort study of bacterial count data from nine hospitals, obtained between 2017 and 2022, anesthesia attending and assistants’ hands, patient skin sites (nares, axilla, and groin), and anesthesia machine (adjustable pressure-limiting valve and agent dials) reservoirs were sampled at case start and at case end. The patient intravenous stopcock set was sampled at case end. The isolation of ≥ 1 CFU of Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Enterococcus, vancomycin-resistant Enterococcus, gram-negative (i.e., Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter spp.) or coagulase-negative Staphylococcus was compared for reservoir samples returning ≥ 100 CFU vs those returning < 100 CFU.

Results

Bacterial pathogens were isolated from 24% (7,601/31,783) of reservoir samples, 93% (98/105) of operating rooms, and 83% (2,170/2,616) of cases. The ratio of total pathogen isolates to total CFU was < 0.0003%. Anesthesia machine reservoirs returned ≥ 100 CFU for 44% (2,262/5,150) of cases. Twenty-three percent of samples returning ≥ 100 CFU were positive for ≥ 1 bacterial pathogen (521/2,262; 99% lower confidence limit, 22%) vs 3% of samples returning < 100 CFU (96/2,888; 99% upper limit, 4%).

Conclusions

Anesthesia machine reservoir samples returning < 100 CFU were associated with negligible pathogen detection. This threshold can be used for assessment of terminal, routine, and between-case cleaning of the anesthesia machine and equipment. Such feedback may be useful because the 44% prevalence of ≥ 100 CFU was comparable to the 46% (25/54) reported earlier from an unrelated hospital.

The relative risk of pathogens cultured from the adjustable pressure-limiting valve and agent dial of the anesthesia machine with ≥ 100 CFU was 6.93 relative to those same sites with < 100 CFU (99% confidence interval, 5.25 to 9.14; P < 0.0001). Given that we lacked prior data, we calculated how many more samples with bacterial pathogens could have been obtained for the < 100 CFU samples to continue to have upper 99% confidence limit < 5%. That would have been 21 more samples, because 117/2,888 has an upper 99% limit of 4.99%.

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Titel: A threshold of 100 or more colony-forming units on the anesthesia machine predicts bacterial pathogen detection: a retrospective laboratory-based analysis
verfasst von: Franklin Dexter, MD, PhD, FASA
Kaitlin M. Walker
Carmen Troncoso Brindeiro, PhD
Chase P. Loftus
Cornelie C. L. Banguid, MPH
Randy W. Loftus, MD
Publikationsdatum: 27.02.2024
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 5/2024
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-024-02707-3

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A threshold of 100 or more colony-forming units on the anesthesia machine predicts bacterial pathogen detection: a retrospective laboratory-based analysis