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Publication Date



UM campus only

Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Epidemiology (Medicine)

Date of Defense


First Committee Member

Kristopher L. Arheart

Second Committee Member

David J. Birnbach

Third Committee Member

Guillermo Prado

Fourth Committee Member

John C. Beier


During the past couple of decades, several studies have emerged on the relevance of the environment and patients body surfaces on the mechanisms of transmission of multidrug resistant organisms. We now know that the transmission pathways from colonized to non-colonized patients involve healthcare workers hands, contaminated equipment, and shared objects. These interactions are particularly relevant in settings with high number of hand contacts and low frequencies of hand hygiene, such as the anesthesia area within operating rooms. Mounting data on infection control behaviors among anesthesia providers while providing anesthesia care indicate that the frequency of hand hygiene during these encounters is low. However, we cannot determine the ideal number of hand hygiene events without a clear understanding of the frequency and type of contacts that anesthesia providers have with their environment while providing anesthesia care in the operating room. Within this framework, the aims of this thesis are: 1). To describe the interactions of anesthesiologists with their environment and patients while providing anesthesia care, 2). Quantify and contrast these interactions during the induction and maintenance, and 3). Evaluate the impact of a hand rub dispenser placed within the anesthesia area on hand hygiene frequency, all while in the operating room. These aims were accomplished by: 1). Observing a convenience sample of anesthesia procedures while capturing the type of objects touched by anesthesia providers, 2). Randomly selecting operating rooms for observation during the first 120 minutes of anesthesia care, and 3). Performing a randomized crossover trial using hand sanitizer dispensers placed on the anesthesia machines and measuring their impact on hand hygiene frequency. Our findings suggest that objects touched most frequently by anesthesiologists included the anesthesia machines and keyboards. Additionally, the frequency of contacts during induction was higher than during maintenance (154.8 ± 7.7 vs. 60 ± 3.1 contacts per hour; p<0.0001). There was a slightly higher frequency of hand hygiene during induction when compared to maintenance (1.8 ± 0.27 vs. 1.19 ± 0.27 events per hour; p=0.018). Finally, the hand sanitizer dispenser on top of the anesthesia machine only increased the hand hygiene rate from 0.5 to 0.8 events per hour (p=0.01). In summary, our findings suggest that anesthesiologists have a high frequency of contacts with their environment and patients’ body surfaces with a relatively low hand hygiene frequency during anesthesia care in the operating room. Therefore, future research should include redefining the moments of hand hygiene into more realistic expectations for this unique setting and determining optimal interventions to improve compliance among anesthesia providers with infection control behaviors in the operating room.


Hand hygiene; Anesthesiology; Operating Rooms