Sterile Practice

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Sterile Practice Monitoring Audit

• Dr. R. Marcus
• Dr. N. Davis-Gomez
• Ms. J. McKeogh
• Birmingham Childrens Hospital

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Aim

• Re-audit for anaesthetic procedures
• Grade of Anaesthetist
• Sterile precautions
• Monitoring

3
Anaesthetic Procedures Monitored

• Single Shot Caudal
• Caudal Catheters
• Epidurals (catheters single shot)
• Central Venous Catheter
• Intra-arterial Catheters
• Peripheral Nerve Blocks

4
Department Guidelines in practice

• Maximal Barrier Precautions
• Full hand washing
• Sterile gloves
• Gown
• Cap
• Mask
• Large Sterile drapes
• Alcoholic Chlorhexidine gluconate or alcoholic
  Povidine-iodine solution

5
Departmental Guidelines

• Limited Barrier Precaution
• Sterile gloves
• Small drapes
• Hand washing
• Skin Preparation

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Department Policy

• Maximal Barrier Precaution
• Central venous catheter
• Spinals
• Epidurals (with or without catheters)
• Caudal with catheter
• Limited Barrier Precautions
• Single Shot Caudal
• Peripheral Nerve Blocks

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Monitoring

• AAGBI guidelines
• Minimum for maintenance of anaesthesia
• SpO2 ECG NIBP ETCO2 ETAA

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Method

• Tick box sheet
• Covertly completed by ODPs
• Procedures assessed
• Epidural (with without catheters)
• Single shot caudals
• Caudal catheter
• Central venous catheter
• Intra-arterial catheter
• Peripheral nerve blocks

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Method

• Monitoring
• SpO2
• ECG
• BP
• ETCO2
• ETAA
• Temp

• Sterile Technique
• Gloves
• Gown
• Mask
• Skin Prep
• Drapes

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Results- Numbers of episodes

• 2007
  2005
• Epidural 14 (25)
  17 (24)
• Caudal Single Shot 16 (29) 29
  (41)
• Caudal Catheter 1 (2)
  2 (3)
• CVC 12 (21)
  22 (31)
• I/A Catheter 12 (21)
  0 (0)
• PN Blocks 1 (2)
  0 (0)
• Total 56
  71

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Results

• Grade of Anaesthetist
• 2007
  2005
• Consultant 39/56 (70) 52/71 (73)
• SpR 17/56 (30) 19/71
  (27)

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Results- Epidurals

• Grades of Anaesthetist
• 2007
  2005
• Consultant 9(64) 14(82)
• SpR 5(36) 3(18)
• Total 14 17

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Results- Epidurals

• Precautions
• 2007
  2005
• Hands washed 13/14 (93) 16/17
  (94)
• Gloves 14/14 (100)
  17/17 (100)
• Gown 13/14 (93)
  9/17 (53)
• Mask 11/14 (79)
  7/17 (41)
• Skin Prep 14/14 (100)
  16/17 (94)
• Drapes 13/14 (93)
  16/17 (94)

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Results- Epidurals

• Monitoring
• 2007
  2005
• SpO2 14/14 (100)
  17/17 (100)
• ECG 11/14 (79)
  7/17 (41)
• BP 8/14 (57)
  5/17 (29)
• ETCO2 9/14 (64) 13/17
  (76)
• ETAA 5/14 (36)
  13/17 (76)
• Temp 4/14 (29)
  1/17 (6)

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Results- Single Shot Caudal

• Grades of Anaesthetist
• 2007
  2005
• Consultant 9/16 (56) 24/29
  (82)
• SpR 7/16 (44) 5/29
  (18)

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Results- Single Shot Caudal

• Precautions
• 2007
  2005
• Hands washed 16/16 (100) 23/29
  (79)
• Gloves
• Sterile 15/16 (94)
  24/29 (83)
• Non-sterile 0/16 (0)
  2/29 (7)
• None 1/16 (6)
  3/29 (10)
• Gown 0/16
  0/29
• Mask 0/16
  0/29
• Skin Prep 14/16 (88)
  25/29 (86)
• Drapes 5/16 (31)
  6/29 (21)

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Results-Single Shot Caudal

• Monitoring
• 2007
  2005
• SpO2 16/16 (100) 29/29
  (100)
• ECG 10/16 (63)
  9/29 (31)
• BP 1/16 (6)
  2/29 (7)
• ETCO2 12/16 (75) 20/29
  (70)
• ETAA 4/16 (25)
  10/29 (34)
• Temp 0/16 (0)

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Result- Central Venous Catheter

• Grades of Anaesthetist
• 2007
  2005
• Consultant 11/12 (92) 14/22 (64)
• SpR 1/12 (8) 8/22
  (36)

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Results-Central Venous Catheter

• Precautions
• 2007
  2005
• Hands washed 11/12 (92) 22/22 (100)
• Gloves 12/12 (100) 22/22 (100)
• Gown 9/12 (75) 19/22
  (86)
• Mask 9/12 (75) 12/22
  (55)
• Skin Prep 12/12 (100) 21/22 (95)
• Drapes 12/12 (100) 21/22 (95)

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Mask
Gloves
Drapes
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Result- Central Venous Catheter

• Monitoring
• 2007
  2005
• SpO2 12/12 (100) 22/22 (100)
• ECG 12/12 (100) 22/22 (100)
• BP 11/12 (92) 20/22 (91)
• ETCO2 12/12 (100) 22/22 (100)
• ETAA 6/12 (50) 20/22 (91)
• Temp 6/12 (50) 13/22 (59)

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Results- Caudal Catheter

• Grades of Anaesthetist
• 2007
  2005
• Consultant 0/1 0/2
• SpR 1/1
  2/2

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Results- Caudal Catheter

• Precautions
• 2007
  2005
• Hand washed 1/1
• Gloves 1/1 2/2
• Gown 1/1 0/2
• Mask 1/1 0/2
• Skin Prep 1/1 2/2
• Drapes 1/1 2/2

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Results- Caudal Catheter

• Monitoring
• 2007
  2005
• SpO2 1/1 2/2
• ECG 1/1 0/2
• BP 1/1 0/2
• ETCO2 1/1 1/2
• ETAA 0/1 1/2
• Temp 0/1 0/1

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Results- Intra-arterial Catheter

• Grade of Anaesthetist
• 2007
  2005
• Consultant 9/12
• SpR 3/12

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Results- Intra-arterial catheter

• Precautions
• Hand washed 9/12
• Gloves
• Sterile 0/12
• Non sterile 3/12
• None 9/12
• Gown 0/12
• Mask 0/12
• Skin Prep 5/12
• Drapes 0/12

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Results- Intra-arterial Catheter

• Monitoring
• 2007
• SpO2 12/12 (100)
• ECG 10/12 (83)
• BP 8/12 (67)
• ETCO2 9/12 (75)
• ETAA 6/12 (50)
• Temp 5/12 (42)

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Results- Peripheral Nerve Blocks

• Grade of anaesthetist
• Consultant 1/1
• Precautions
• Hand washed
• No gloves
• Skin Prepped
• No drapes
• Monitoring
• SpO2 used

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Discussion

• General improvement in sterile precautions
  undertaken
• SpO2 monitoring for almost all procedures
• ECG monitoring for all CVC insertions
• Need to improve upon the use of drapes for single
  shot Caudal
• ? Need for guidelines for monitoring

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Conclusion

• There has been a overall improvement in sterile
  precautions and monitoring when undertaking key
  anaesthetic procedures