Letter To The Editor: Could Part Of The Alarming Rise In Nosocomial Infections Have Anything To Do With Today's Often Careless Airway Secretion Management Approach?

摘要

This question is quite relevant, since millions of patients require airway suctioning during the course of their care -- be it in: anesthesia, critical care, emergency room, endoscopy unit, nursing home, rehabilitation center or ambulance settings.Saliva, airway secretions and the suction tubes they are aspirated with are contaminated with blood, bacteria, viruses and fungi. Unfortunately, these tubes and secretions are often not contained adequately. Behind closed doors and curtains, used suction tubes often hang unprotected from the anesthesia machine, are pushed under a mattress, or lie by the patient where they brush against equipment, work surfaces and personnel. In this type of contaminated environment, supposedly sterile intravenous catheters, central venous lines and endotracheal tubes may provide ready avenues for nosocomial infection. How many pneumonias or septic episodes might not be prevented with better techniques? Thousands of patients and billions of dollars are needlessly lost to hospital acquired infection every year, in the USA.Although it has taken health-care providers almost a decade to become used to wearing non-sterile gloves, many are still dripping airway secretions throughout the medical workplace. While the CDC has already provided “Universal Precautions” guidelines and OSHA has published “The Blood Borne Pathogens Standard,” most examiners still seem to be overlooking this all too common fault in suctioning technique. Nevertheless, it is hopeful that in an issue of “Briefings on Hospital Safety” (June 1997), Carole Paterson, the JACHO’s department of standards Deputy Director, says “...environment of care implementation and design and infection control are on the random unannounced survey list for nearly all JACHO accreditation programs.”Even the lay press is raising concerns regarding the emergence of more resistant micro-organisms. A recent review in JAMA identifies a failure to use basic infection control practices as a major cause. The New York Times Magazine lead article from August 2nd entitled Superbugs The BACTERIA Antibiotics Can’t Kill, describes how the CDC is currently closely monitoring the threat posed by some strains of Vancomycin Intermediate-Resitant Staphylococcus Aureus. They consider this sitituation to represent the bacterial world’s most potent counterattack against antibiotics. As we all know, staph is a particuarly common organism, which lives on the skin and in the nostrils of otherwise healthy people. It is part of what is considered our normal flora, were it is relatively harmless. If it gains access to the body through scrapes, incisions, etc. it can cause serious problems. Should VISA strains become widespread the problem would become far more severe. Health care workers can transmit staphylococcus when their hands become infected from contact with patients or body fluids. Clearly, for all of the above reasons, we need to examine our routine practice and heighten our consciousness about the very real risks posed by airway secretions and suction tubes. Although it is not widely known yet, oral suction tube holder disposable devices are now available to better manage this contamination risk.;Airway Secretions and Blood An Anesthesia / Critical Care PerspectiveI am not sure that many physicians have considered the serious opportunity for nosocomial infection provided by our often improper management of airway secretions in the peri-operative period. Although anesthesia, critical care, and other medical staff are well aware of the potential spread of bacteria, viruses, and fungi from saliva, other upper airway secretions and blood during oro-pharyngeal manipulation, too much complacency still exists. After some thought, most would agree that this daily danger needs to be urgently addressed in a more practical and standardized manner.A recent study in Anesthesia and Analgesia showed that 33% of anesthesia equipment surfaces were contaminated with blood, and that visual inspe