Antisepsis in the time of antibiotics: following in the footsteps of John Snow and Joseph Lister.

摘要

If John Snow, a founding father of both anesthesiology and epidemiology, were alive today, undoubtedly he would attack the problem of health care-associated infections (HCAIs) as doggedly as he approached the 1854 cholera epidemic in London. Although Snow did not know that Vibrio cholerae was the causative organism, he clearly demonstrated that cholera was communicated by drinking contaminated water from the Broad Street pump. Conversely, in the case of HCAIs associated with surgery, the causative organisms are readily determined, yet the source and mechanism of transmission are frequently unclear. Following in the footsteps of Snow are Koff, Loftus, and their Dartmouth colleagues. They are exploring whether anesthesia providers are the source, or vectors for the transmission, of bacteria that cause surgical site infections (SSIs). In earlier publications, they documented transmission of pathogenic bacteria to the anesthesia operating room work area and established an association between contamination of this area and contamination of IV stopcocks, between contaminated stopcocks and nosocomial infections, and between contamination, nosocomial infection, and hand hygiene by anesthesia providers.