Anaesthesia, 1999, 54, pages 13–18

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Hygienic practices of consultant anaesthetists:

a survey in the North-West region of the UK

N. El Mikatti,1 P. Dillon2 and T. E. J. Healy3

1 Consultant, 2 Senior Regsitrar and 3 Professor, Anaesthetic Department of TU 3, South Manchester University Hospital
NHS Trust, Withington Hospital, Manchester M20 8LR, UK

Summary
Questionnaires were distributed to all 213 consultant anaesthetists in the North-West region of the
UK with a response rate of 68%. These questionnaires were designed to assess the hygienic
precautions taken to reduce the potential for transmission of infectious agents to and from the
patients under their care. Face masks and gloves were always used by 35.2% and 14.5%,
respectively, while only 36.4% washed their hands between cases. Most respondents have changed
their practice since the recognition of HIV transmission (74.8%) and hepatitis B and C (69.8%). A
high proportion of anaesthetists continue to administer anaesthesia despite suffering from
respiratory (94%), gastrointestinal (42.9%) or herpes simplex (32.6%) infections. The anaesthetic
breathing system was changed at the end of each day or following a high-risk case by 33.3% of the
respondents, while just over 25% changed it following a known infected case. Bacterial filters were
used by 17% and changed after each case by 7.2%. On a scale of 0–10 (10 ¼ significant)
anaesthetists rated their potential for transmitting or contributing to patient infection as a median
of 3 (interquartile range: 2–6). The results of this study show that, although anaesthetists are well
aware of proper hygienic practices, their performance falls short of accepted recommendations.

Keywords Infection; contamination. Equipment; laryngoscopes.

......................................................................................
Correspondence to: N. El Mikatti
Accepted: 23 June 1998

The principles of antisepsis and asepsis introduced more virus (HBV) infection [1]; revised guidance was issued in
than a century ago are the cornerstones of modern surgery, December 1992 [2]. These guidelines include recommen-
yet patients continue to be plagued by postoperative wound dations to wear gloves during induction of anaesthesia,
sepsis. Although the mortality associated with postopera- inserting intravenous cannulae, setting up intravenous
tive sepsis has been notably reduced, the morbidity and infusions and inserting and removing airways and tracheal
surgical failure attributable to sepsis warrant further efforts tubes. Where substantial spillage of blood may occur, as,
to identify factors responsible for sepsis and to reduce the for example, in setting up an intra-arterial line, a plastic
rate of wound infection. apron, mask and eye protection should be worn. Where
The relationship between anaesthetic practice and peri- possible, nondisposable, contaminated equipment should
operative infection has not been established. Anaesthetists be autoclaved. Where this is not possible the equipment
are, however, involved in instrumentation of the respira- should be thoroughly washed with detergent and left for a
tory tract, the cardiovascular system and other internal body suitable period in 2% freshly prepared glutaraldehyde or
spaces and would therefore appear to be a potent source of other agent recommended by local infection control policies.
organisms, not only between anaesthetist and patient, but Following publication of the guidelines, the Association
also between patients who share the operating theatre and was presented with evidence that the precautions against
the same anaesthetist. occupational transmission recommended in 1988 had by
In 1988, the Association of Anaesthetists of Great no means been universally implemented by anaesthetists in
Britain and Ireland published guidelines to its members the UK [3].
regarding the occupational hazards of HIV and hepatitis B A survey was carried out during 1997 among consultant

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N. El Mikatti et al. • Hygienic practices of consultant anaesthetists Anaesthesia, 1999, 54, pages 13–18
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anaesthetists in the North-West region of the UK to assess was recorded; 35% had been in post for more than 15
present standards of hygiene and discipline and to highlight years, 21.7% had been in post between 10 and 15 years,
areas of practice which may be less than optimal. This was 19.6% between 5 and 10 years, while 23.7% had been
based on a similar survey carried out in the USA [4]. appointed within the previous 5 years.
Table 1 shows the frequency of use of face masks, gloves
and hand washing between cases. Using the Chi-squared
Methods
test there was no significant difference in the use of masks
Data for the study were collected using a questionnaire or frequency of hand washing between consultants with
(Appendix A) distributed with an addressed envelope to respect to their seniority. Using the same test for linear
213 consultant anaesthetists working in the North-West association (Mantel–Haenszel), however, a greater pro-
region of the UK at the start of the study. The questions, portion of consultants who had been in post for less than
modified slightly from a similar US study [4], were designed 10 years frequently or always wore gloves compared with
to be completed anonymously to reduce the potential for those practising for more than 10 years (Chi-squared value
self-report bias. In order to ensure confidentiality, we did marginally significant, p ¼ 0.059). Unfortunately 70% of
not ask for the name or place of practice of the respondents anaesthetists in the study did not answer the question
and private practice was not included in the study. Ethics about changing gloves between cases while 20.7% gave a
committee approval was not sought as this study was an positive answer.
audit of anaesthetists’ attitudes and did not impact upon The response to questions involving the use of aseptic
patient care. We allowed 3 months for return of the replies technique (defined as using skin preparation) for intra-
before the study was closed. venous cannulation, scrubbing for neuraxial blocks (defined
Statistical analysis included calculation of the confidence as taking full sterile precautions), wiping anaesthetic
interval (95% CI) for all the respondents. The median and machine/working surfaces, use of syringe for more than
interquartile range were used to describe how respondents one patient and disinfection of multidose vials are shown
scored their potential for transmitting infection. The mean in Table 2. All respondents claimed to clean/disinfect the
and standard error were also calculated for the purpose of laryngoscope after each patient, with 59% using soap and
comparison with the North American study. Categorical water.
variables were analysed using frequency distribution, Chi- One third of the respondents (33.3%) changed the
squared analysis and the Mantel–Haenszel test for associ- disposable breathing circuit at the end of the day or after
ation. A value of p < 0.05 was considered significant. an infected/high-risk patient, while 27% always changed it
following a known infected case. Only 1.3% of anaesthe-
tists changed the breathing system after each case. Bacterial
Results
filters were used by 17% and changed between cases by 7.2%.
The questionnaires were distributed to 213 consultant Most anaesthetists admitted anaesthetising patients whilst
anaesthetists of which 145 were returned completed giving harbouring respiratory tract (94%), gastrointestinal (42.9%)
a response rate of 68%. The seniority of the consultants and herpes simplex (32.6%) infections.

Table 1 The frequency of use (%) of face

Surgeon/Sister mask, gloves and hand washing between
Never Rarely Frequently Always request cases.
Face mask 2.1 26.1 33.1 35.2 3.5
Gloves 3.4 42.1 40 14.5 ¹
Hand washing 1.4 14.7 47.5 36.4 ¹

Table 2 The frequency (%) of other aspects

Never Rarely Frequently Always of hygienic practice.

Aseptic technique for intravenous cannulation 11.3 18.3 16.2 54.2

Scrub for spinal/ epidural block 7.0 9.9 11.3 71.8
Wiping anaesthesia working surface 18.7 33.1 27.3 20.9
Reuse of syringes 80 13.1 6.9 0
Disinfect septum of multidose vials* 17.5 21.2 12.4 39.4

* 9.5% of respondents never used multidose vials.

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Anaesthesia, 1999, 54, pages 13–18 N. El Mikatti et al. • Hygienic practices of consultant anaesthetists
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Changing anaesthetic practice in consideration of sterile instruments [13, 14] especially in theatres with
AIDS as a dangerous infectious disease was reported by forced ventilation [15]. However, no member of the
74.8% of the respondents; 23.8% did not change their theatre staff can exclude themselves completely from
practice while 1.4% were not sure. Recognition of the either the surgical site or the sterile instruments trolley.
possibility of hepatitis B and C virus (HB/CV) infection Microbial contamination in surgical theatres did not differ
changed anaesthetic practice in 68.8% of the respondents; when face masks were not worn [16]. In fact Tunevall [17]
28.8% did not change while 1.4% did not know. concluded that masks provide no benefit to patients. It is
The anaesthetist’s role in the transmission of infectious generally recommended that masks should be used by
agents to the patients was scored on a scale of 0–10 (10 ¼ people suffering from nasopharyngeal rhinoviral infection,
significant); 46.4% of the respondents rated it higher than but it is more sensible to exclude them from the surgical
5, 4.9% perceived it as 0, while it was reported as 10 by suite. In addition rhinoviral transmission has been shown
only 3.5%. The modal score was 2 (25% of respondents). to spread by hand-borne contamination, rather than by
The median score was 3 with an interquartile range of droplet transfer; this again raises the question about the
2–6. Anaesthetists in the North American study scored necessity for the mask [18]. Nevertheless when no mask
the anaesthetists’ potential for transmitting infection to the was worn a significantly (p < 0.002) higher number of
patient significantly higher than in the present study [mean bacterial colonies were recoverable than when a full mask
(SEM) 4.7 (0.12) compared with 3.38 (0.21)]. was worn; mask placement, however, above or below the
nose made no significant difference to the mean colony
counts [19]. In the present study, about 94% of anaesthe-
Discussion
tists administered anaesthesia whilst suffering from upper
The scope of intra-operative infection control must be respiratory tract infection; this result was comparable
broadened to protect surgeons, other theatre personnel with that reported in the North American study [4]. It is
and patients [5, 6]. This is more vital in patients who are recommended, however, that all persons entering the
already predisposed to infection such as those who are restricted areas of the surgical suite should wear masks,
burned, obese, elderly, diabetic or those with poor nutri- masks should be worn at all times in the operating room,
tional status such as alcoholics and drug abusers. Anaesthe- and should cover both the mouth and nose and be properly
tists may be faced with patients who have acquired or secured [20]. Face masks decrease the spread of contami-
congenital immunosuppressive diseases or who are receiving nated droplets by filtration and alter the direction of
immunosuppressive medications [4]. Infection is one of the dispersal from the upper respiratory tract during talking,
major causes of morbidity and mortality in these patients. coughing and breathing. It is also recommended that
Anaesthetic practice has the potential for transmitting a masks should be removed and discarded after use since
number of infectious agents to the patients. Intravenous or they become wet and laden with micro-organisms. Stan-
intra-arterial catheterisation, neuraxial and local blockade, dardised tests are needed to evaluate the ability of face
invasive monitoring and instrumentation of the airway are masks to protect the user from a variety of particle sizes and
examples of violation of the body’s mechanical barriers to quantify edge leakage [21]. Recently, Heinsohn &
which may lead to infection. The role of infection Jewett [22] recommended the proper use of respiratory
transmission by blood and body fluid contamination of protection equipment instead of surgical masks because
regularly used theatre equipment such as stopcocks [7], the latter do not offer adequate protection against aero-
anaesthesia machines, pulse oximeter probes, monitor solised blood in the operating room. The present study
cables [8] and patient anaesthesia records [9] has not confirmed that, in spite of the recommendations, the
been established. The prevention of percutaneous injuries respondent anaesthetists do not consider the wearing of
must remain the highest priority for the protection of face masks to be important, with only 35.2% and 33.1%
personnel during the intra-operative period. always and frequently, respectively, using them. North
There is no doubt that wearing a face mask in surgical American anaesthetists [4] use face masks more frequently,
theatres is a controversial topic. Since its initial use by a with corresponding figures of 75.3% (p < 0.05) and 19.5%.
German surgeon in 1897 [10], the surgical mask has been The anaesthetic nurses in the South Manchester Univer-
repeatedly modified, scrutinised and criticised. Rogers sity Hospital NHS Trust have been informed that a face
[11] recommended that surgeons, assisting nurses and mask need be worn only by the scrub team except for
anaesthetists should wear masks. This was supported by orthopaedic surgery.
increased rates of infection after major abdominal surgery The respondents in the present study rarely (42.1%) or
when surgeons and nurses did not wear masks [12]. Masks, always (14.5%) wore gloves during anaesthesia. This find-
however, may not be necessary for theatre staff who are ing was significantly different (p < 0.05) from the North
not in close communication with the surgical field and the American study [4] in which 12.7% and 49.4% rarely or

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always, respectively, used gloves. The incidence of contact Despite the recommendations of The Association of
with blood among anaesthetic personnel has been esti- Anaesthetists of Great Britain and Ireland [1, 2] regarding
mated to range from 8% for intramuscular injection to HIV and HBV, these are not strictly implemented. In
87% for central venous catheter insertion; 98% of these terms of risk, HBV is the most important virus to which
incidents of blood contact are avoided by the use of gloves the anaesthetist is exposed [36], and it has long been
[23]. Routine hand washing between cases, another simple associated with anaesthetic practice [37]. It has been
hygienic practice, was always performed by only 50% of recently agreed that HIV- or HBV-infected anaesthetists
the anaesthetists in both studies, although it was shown who are clinically well can continue in clinical practice
experimentally that transmission of rhinovirus infection [28]. This view was supported by the UK Health Depart-
occurs much more frequently via the hands than via sneez- ments’ Advisory Panel on Health Care Workers Infected
ing and coughing [24]. There was a significant difference with Blood Viruses (UKAP) with the exception of those
(p < 0.05) in another simple hygienic procedure; 85% of procedures which involved skin tunnelling. Our study has
the North American anaesthetists, compared with 54.2% shown that most anaesthetists have changed their practice
of respondents in the present study, always used skin prepa- in recognition of the risks from HIV and HB/CV (74%
ration before placing an indwelling cannula. and 68.8%, respectively). Tait & Tuttle [36] reported a
There was a significant difference (p < 0.01) with respect substantial alteration in practice by 58% of anaesthetists in
to changing the patient’s disposable breathing circuit. Tait light of the AIDS epidemic, while practice was somewhat
& Tuttle [4] reported that 88.4% of their respondents, altered by 35.3%.
compared with 1.3% in the present study, always changed In summary, this study shows that, whereas most anaes-
it after each patient use; this difference was also significant thetists are aware of the occupational hazards, they do not
(p < 0.01) in their private practice. The breathing circuit strictly follow the recommended precautions. This may be
was changed at the end of the day by 16.4% of the anaes- dangerous if there are an increasing number of undetected
thetists reporting in the present study compared with 3.2% HIV and HBV infections to which the anaesthetists may
in the North American study [4]. The filter was changed be exposed. The risks were emphasised strongly by The
between cases by 7.2% of the respondents in the present Association of Anaesthetists in their revised guidance in
study, but it is likely that, in the year since the study was 1992 [2].
undertaken, the use of bacterial filters has increased. It has Although the number of the anaesthetists involved in
been shown that anaesthetic breathing systems can become the present study was small, it showed clearly that some still
contaminated with organisms from the respiratory tract, do not adhere to the recommendations laid down by the
especially with coughing [25–28]. It is recommended that Association of Anaesthetists. Many points need considera-
either an appropriate filter should be placed between the tion; one of these, for example, is the wearing of gloves
patient and the breathing system, with a new filter being and washing of hands between cases. We suggest that every
used for each patient, or that a new breathing system be anaesthetic department should have a written protocol for
used for each patient, especially in paediatric practice [3]. hygienic standards and discipline in the operating theatre.
A contaminated reusable part of the breathing system can Appropriate training and education of all anaesthetic
possibly result in HCV infection [29]. However, the use of personnel should be organised to implement the recom-
disposable anaesthetic circuits with bacterial filters has not mendations of the Association of Anaesthetists of Great
been shown to reduce the incidence of postoperative Britain and Ireland. However, it is equally important that
pulmonary infection [30, 31]. those nurses and orderlies working in the theatre suite and
The practice of reusing disposable plastic syringes for who may approach close to the operation site or the sterile
different patients is still prevalent in North American instruments should also be subject to strict hygienic
theatres despite warnings about the hazards [32–34]. The discipline.
use of a syringe for more than one patient was never (80%)
and rarely (13.1%) practised, respectively, by the anaes-
Acknowledgment
thetists in the study reported here. The multiple use was
mainly for total intravenous anaesthesia for which only the We thank Dr Alan R. Tait, University of Michigan
infusion line was changed. The IV tubing, however, has Medical Center, for agreeing to the use of his question-
been shown to have a significant contamination rate in naire in the study.
routine use; the rate decreasing as the distance from the IV
catheter increases [35]. Tait & Tuttle [4] reported that 28%
References
of anaesthetists in private practice frequently or always
reuse syringes for more than one patient compared with 1 Association of Anaesthetists of Great Britain and Ireland.
7% in university practice (p < 0.01). AIDS and Hepatitis B Guidelines for Anaesthetists, 1988.

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2 Association of Anaesthetists of Great Britain and Ireland. 22 Heinsohn P, Jewett DL. Exposure to blood-containing
HIV and Other Blood-Borne Viruses – Guidance for aerosol in the operating room: a preliminary study.
Anaesthetists, 1992. American Industrial Hygiene Association Journal 1993; 54:
3 A Report Received by Council of The Association of 446–53.
Anaesthetists on Blood Borne Viruses and Anaesthesia. An 23 Kristensen MS, Sloth E, Jensen TK. Relationship between
Update. January, 1996. anaesthetic body fluids. Anesthesiology 1990; 73: 619–24.
4 Tait AR, Tuttle DB. Preventing perioperative transmission 24 Gwaltney JM, Moskalski PB, Hendley JO. Hand-to-hand
of infection: a survey of anesthesiology practice. Anesthesia transmission of rhinovirus colds. Annals of Internal Medicine
and Analgesia 1995; 80: 746–9. 1978; 88: 463–7.
5 Gerberding JL, Schecter WP. Surgery and AIDS. Reducing 25 Nielsen H, Vasegaard M, Stokke DB. Bacterial
the risk. Journal of the American Medical Association 1991; contamination of anaesthetic gases. British Journal of
265: 1572–3. Anaesthesia 1978; 50: 811–14.
6 McPherson DC, Parris NB. Reducing occupational 26 Nielsen H, Jacobsen JB, Stokke DB, Brinklove MM,
exposure to blood in the OR. Today’s OR Nurse 1992; 14: Christensen KN. Cross-infection from contaminated
23–7. anaesthetic equipment. A real hazard? Anaesthesia 1980; 35:
7 Dryden GE, Brickler J. Stopcock contamination. Anesthesia 703–8.
and Analgesia 1979; 58: 141–2. 27 Leijten DT, Rejger VS, Mouton RP. Bacterial
8 Hall JR. Blood contamination of equipment and contamination and the effect of filters in anaesthetic circuits
monitoring equipment. Anesthesia and Analgesia 1994; 78: in a simulated patient model. Journal of Hospital Infection
1136–9. 1992; 21: 51–60.
9 Merritt Wt, Zuckerberg AL. Contamination of the 28 du Moulin GC, Hedley-Whyte J. Bacterial interactions
anaesthetic records. Anesthesiology 1992; 77: A1102. between anesthesiologists, their patients and equipment.
10 Mikulicz J. Das Operinen in sterilisirten Anesthesiology 1982; 57: 37–41.
Zwirnhandschuhen und mit Mundbinde. Centralblatt Fur 29 Chant K, Kociuba K, Monro R et al. Investigation of
Chirurgie 1897; 26: 714. possible patient-to-patient transmission of hepatitis C in a
11 Rogers KB. Face masks: which, when, where and why? hospital. New South Wales Public Health Bulletin 1994; 5:
Journal of Hospital Infection 1981; 2: 1–4. 47–51.
12 Chamberlain GV, Houang E. Trial of the use of masks in 30 Olds JW, Kisch AL, Eberle BJ, Wilson JN. Pseudomonas
the gynaecological operating theatre. Annals of the Royal aeruginosa respiratory tract infection acquired from a
College of Surgeons of England 1984; 66: 432–3. contaminated anaesthesia machine. American Review of
13 Ritter MA, Eitzen HE, Hart JB, French ML. The surgeon’s Respiratory Diseases 1972; 105: 628–32.
garb. Clinical Orthopaedics and Related Research 1980; 153: 31 Feeley TW, Hamilton WK, Xavier B, Moyers J, Eger IIEI.
204–9. Sterile anaesthetic breathing circuits do not prevent
14 Orr NWM. Is a mask necessary in the operating theatre? postoperative pulmonary infection. Anesthesiology 1981; 54:
Annals of the Royal College of Surgeons of England 1981; 63: 369–72.
390–2. 32 Centers for Disease Control. Recommendations for
15 Mitchell NJ, Hunt S. Surgical face mask in modern prevention of HIV transmission in health-care settings.
operating rooms – a costly and unnecessary ritual? Journal Morbidity and Mortality Weekly Report 1987; 36 (Suppl. 2):
of Hospital Infection 1991; 18: 239–42. 1–18.
16 Ritter MA, Eitzen H, French ML, Hart JB. The operating 33 Browne RA, Chernesky MA. Infectious diseases and the
room environment as affected by people and the surgical anaesthetists. Canadian Journal of Anaesthesia 1988; 35:
face mask. Clinical Orthopaedics and Related Research 1975; 655–65.
111: 147–50. 34 Heseltine P. Anesthesiologists should not give IV
17 Tunevall TG. Postoperative wound infection and surgical medications with common syringe. Hospital Infection Control
face masks: a controlled study. World Journal of Surgery 1991; 1986; 13: 84–5.
15: 383–8. 35 Trepanier CA, Lessard MR, Brochu JG, Denault PH. Risk
18 Beck WC. The surgical mask: another ‘sacred cow’? Guest of cross-infection related to the multiple use of disposable
Editorial. AORN Journal 1992; 55: 955–7. syringes. Canadian Journal of Anaesthesia 1990; 37: 156–9.
19 Berger SA, Kramer M, Nagar H, Finkelstein A, 36 Tait AR, Tuttle DB. Prevention of occupational
Frimmerman A, Miller HI. Effect of surgical mask position transmission of human immunodeficiency virus and
on bacterial contamination of the operative field. Journal of hepatitis B virus among anesthesiologists: a survey of
Hospital Infection 1993; 23: 51–4. anesthesiology practice. Anesthesia and Analgesia 1994; 79:
20 Recommended Practices. Surgical Attire AORN Journal 623–8.
1990; 51: 829–37. 37 du Moulin GC, Hedley-White J. Hospital-associated viral
21 Davis WT. Filtration efficiency of surgical face masks: the infection and the anesthesiologist. Anesthesiology 1983; 59:
need for more meaningful standards. American Journal of 51–65.
Infection Control 1991; 19: 16–18.

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a Never
Appendix A
b Rarely
These questions relate to the anaesthetist’s role in limiting the c Frequently
transmission of any type of infectious agent to and from the patient d Always.
intra-operatively. 10 After administering anaesthesia, do you (or technician) ever
wipe the anaesthesia machine/ventilator/working surfaces with a
1 How long have you been a consultant anaesthetist? disinfectant/germicidal agent?
a 0–5 years a Never
b 5–10 years b Rarely
c 10–15 years c Frequently
d > 15 years. d Always.
2 Do you ever wear surgical masks? 11 Do you wipe the rubber septum of a multidose vial with
a Never alcohol prior to use?
b Rarely a Never
c Frequently b Rarely
d Always c Frequently
e On surgeon’s request. d Always.
3 Do you ever wear gloves? 12 Have you ever administered anaesthesia while infected with:
a Never a A respiratory infection (cold, influenza, etc.)
b Rarely 1 Yes
c Frequently 2 No
d Always 3 Don’t know;
e Change them between cases: Yes/No. b A gastrointestinal infection
4 Do you wash your hands between cases? 1 Yes
a Never 2 No
b Rarely 3 Don’t know;
c Frequently c Herpes simplex virus (cold sore, herpetic whitlow)
d Always. 1 Yes
5 Do you use aseptic technique when placing an indwelling 2 No
cannula? 3 Don’t know;
a Never d Psoriasis/dermatitis
b Rarely 1 Yes
c Frequently 2 No
d Always. 3 Don’t know;
6 Do you change the patient’s disposable breathing circuit? e Other (please explain).
a After each patient 13 Did you alter your practice in light of AIDS recognition?
b Only after infected or high-risk patient 1 Yes
c At the end of the day 2 No
d Both (b) and (c) 3 Don’t know.
e Other (please explain). 14 Did you alter your practice in light of Hep.B or C possibility
7 Do you (or a technician) usually clean/disinfect laryngoscope of infection?
blades? 1 Yes
a After each patient 2 No
b Only after an infected or high-risk patient 3 Don’t know.
c At the end of the day 15 On a scale of 0 (none) to 10 (significant), how do you perceive
d Other (please explain). the anaesthetist’s role in transmission of infectious agents to the
8 How do you (or a technician) usually clean/disinfect laryngo- patient (please circle)?
scope blades? None
a Wipe with a clean cloth Significant
b Rinse under running water 0 1 2 3 4 5 6 7 8 9 10.
c Wash with a soap and water 16 Do you scrub before giving spinal or epidural (vs. wearing
d Wipe with an alcohol swab sterile gloves)?
e Clean with disinfectant/germicidal agent a Never
f Clean with Betadine b Rarely
g Autoclave c Frequently
h Other (please explain). d Always.
9 Do you ever use one syringe to administer drugs to more than
one patient?

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