Top

Current Anesthesiology Reports

Published in:

01-09-2020 | COVID-19 | Patient Safety in Anesthesia (SJ Brull, Section Editor)

Perioperative Infection Transmission: the Role of the Anesthesia Provider in Infection Control and Healthcare-Associated Infections

Authors: Archit Sharma, Patrick G. Fernandez, John P. Rowlands, Matthew D. Koff, Randy W. Loftus

Published in: Current Anesthesiology Reports | Issue 3/2020

Abstract

Purpose of Review

This review aims to highlight key factors in the perioperative environment that contribute to transmission of infectious pathogens, leading to healthcare-associated infection. This knowledge will provide anesthesia providers the tools to optimize preventive measures, with the goal of improved patient and provider safety.

Recent Findings

Over the past decade, much has been learned about the epidemiology of perioperative pathogen transmission. Patients, providers, and the environment serve as reservoirs of origin that contribute to infection development. Ongoing surveillance of pathogen transmission among these reservoirs is essential to ensure effective perioperative infection prevention.

Summary

Recent work has proven the efficacy of a strategic approach for perioperative optimization of hand hygiene, environmental cleaning, patient decolonization, and intravascular catheter design and handling improvement protocols. This work, proven to generate substantial reductions in surgical site infections, can also be applied to aide prevention of SARS-CoV-2 spread in the COVID-19 era.

Available only for authorised users

Markel H. In 1850, Ignaz Semmelweis saved lives with three words: wash your hands. 2015.

Control CfD, Prevention N. Personnel. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32:470–85.CrossRef

Koff MD, Brown JR, Marshall EJ, O'Malley AJ, Jensen JT, Heard SO, et al. Frequency of hand decontamination of intraoperative providers and reduction of postoperative healthcare-associated infections: a randomized clinical trial of a novel Hand hygiene system. Infect Control Hosp Epidemiol. 2016;37(8):888–95. https://doi.org/10.1017/ice.2016.106.CrossRefPubMed

•• Loftus RW, Campos JH. The anaesthetists' role in perioperative infection control: what is the action plan? Br J Anaesth. 2019;123(5):531–4. https://doi.org/10.1016/j.bja.2019.07.013This paper discusses the utility the evidence-based tools to achieve perioperative improvements in intravascular catheter design and handling, improved hand hygiene compliance, improved environmental cleaning, and perioperative patient decolonization.CrossRefPubMed

Loftus RW, Koff MD, Brown JR, Patel HM, Jensen JT, Reddy S, et al. The epidemiology of Staphylococcus aureus transmission in the anesthesia work area. Anesth Analg. 2015;120(4):807–18. https://doi.org/10.1213/ANE.0b013e3182a8c16a.CrossRefPubMed

•• Loftus RW, Dexter F, Robinson ADM. High-risk Staphylococcus aureus transmission in the operating room: a call for widespread improvements in perioperative hand hygiene and patient decolonization practices. Am J Infect Control. 2018;46(10):1134–41. https://doi.org/10.1016/j.ajic.2018.04.211 This paper associated transmission of Staphylococcus aureus with provider hands and also demonstrated that improved compliance with hand hygiene and patient decolonization may help to control the spread of these dangerous pathogens.CrossRefPubMed

Roy RC, Brull SJ, Eichhorn JH. Surgical site infections and the anesthesia professionals' microbiome: we've all been slimed! Now what are we going to do about it? Anesth Analg. 2011;112(1):4–7. https://doi.org/10.1213/ANE.0b013e3181fe4942.CrossRefPubMed

National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32(8):470–85. doi: https://doi.org/10.1016/s0196655304005425.

Rupp ME, Fitzgerald T, Puumala S, Anderson JR, Craig R, Iwen PC, et al. Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units. Infect Control Hosp Epidemiol. 2008;29(1):8–15. https://doi.org/10.1086/524333.CrossRefPubMed

10.

Konvalinka A, Errett L, Fong IW. Impact of treating Staphylococcus aureus nasal carriers on wound infections in cardiac surgery. J Hosp Infect. 2006;64(2):162–8. https://doi.org/10.1016/j.jhin.2006.06.010.CrossRefPubMedPubMedCentral

11.

Caffau S, Nadali L. On the bacterial contamination of anesthetic equipment. Friuli Med. 1965;20(4):515–31.PubMed

12.

Friis H, Helms P. Bacterial contamination of anesthetic equipment during use. Ugeskr Laeger. 1963;125:619–23.PubMed

13.

Madar R, Novakova E, Baska T. The role of non-critical health-care tools in the transmission of nosocomial infections. Bratisl Lek Listy. 2005;106(11):348–50.PubMed

14.

Fukada T, Tachibana C, Tsukazaki Y, Satoh K, Furuya Y, Ohe Y. Bacterial contamination of anesthesiologists' hands and the efficacy of handwashing. Masui. 1996;45(8):1026–30.PubMed

15.

Loftus RW, Koff MD, Burchman CC, Schwartzman JD, Thorum V, Read ME, et al. Transmission of pathogenic bacterial organisms in the anesthesia work area. Anesthesiology. 2008;109(3):399–407. https://doi.org/10.1097/ALN.0b013e318182c855.CrossRefPubMed

16.

Loftus RW, Brown JR, Koff MD, Reddy S, Heard SO, Patel HM, et al. Multiple reservoirs contribute to intraoperative bacterial transmission. Anesth Analg. 2012;114(6):1236–48. https://doi.org/10.1213/ANE.0b013e31824970a2.CrossRefPubMed

17.

Songjie, Wu YW, Jin X, Tian J, Liu J, Mao Y. Environmental contamination by SARS-CoV-2 in a designated hospital for coronavirus disease. American Journal of Infection Control. 2020. https://doi.org/10.1016/j.ajic.2020.05.003.

18.

van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 162020:1564–7.

19.

Apostolou A, Bartholomew ML, Greeley R, Guilfoyle SM, Gordon M, Genese C, et al. Transmission of hepatitis C virus associated with surgical procedures - New Jersey 2010 and Wisconsin 2011. MMWR Morb Mortal Wkly Rep. 2015;64(7):165–70.PubMedPubMedCentral

20.

Branch-Elliman W, Weiss D, Balter S, Bornschlegel K, Phillips M. Hepatitis C transmission due to contamination of multidose medication vials: summary of an outbreak and a call to action. Am J Infect Control. 2013;41(1):92–4. https://doi.org/10.1016/j.ajic.2012.01.022.CrossRefPubMed

21.

DeMaria A Jr, Snydman DR. Nosocomial hepatitis C: more of a hidden epidemic. Ann Intern Med. 2012;7. United States:534–5.CrossRef

22.

Blot K, Bergs J, Vogelaers D, Blot S, Vandijck D. Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clin Infect Dis. 2014;59(1):96–105. https://doi.org/10.1093/cid/ciu239.CrossRefPubMedPubMedCentral

23.

•• Loftus RW, Dexter F, Goodheart MJ, Mcdonald M, Keech J, Noiseux N, et al. The effect of improving basic preventive measures in the perioperative arena on Staphylococcus aureus transmission and surgical site infections: a randomized clinical trial. JAMA Netw Open. 2020;3(3):e201934. https://doi.org/10.1001/jamanetworkopen.2020.1934 This randomized clinical trial demonstrated that improved basic preventive measures in the perioperative arena can reduce Staphylococcus aureus transmission and surgical site infections.CrossRefPubMed

24.

•• Dexter F, Parra MC, Brown JR, Loftus RW. Perioperative COVID-19 defense: an evidence-based approach for optimization of infection control and operating room management. Anesth Analg. 2020. https://doi.org/10.1213/ANE.0000000000004829 This paper describes an evidence-based approach for optimization of infection control and operating room management during the COVID-19 pandemic.

25.

Helms B, Dorval S, Laurent PS, Winter M. Improving hand hygiene compliance: a multidisciplinary approach. Am J Infect Control. 2010;38(7):572–4. https://doi.org/10.1016/j.ajic.2009.08.020.CrossRefPubMed

26.

Biddle C, Shah J. Quantification of anesthesia providers' hand hygiene in a busy metropolitan operating room: what would Semmelweis think? Am J Infect Control. 2012;40(8):756–9. https://doi.org/10.1016/j.ajic.2011.10.008.CrossRefPubMed

27.

Tait AR, Tuttle DB. Preventing perioperative transmission of infection: a survey of anesthesiology practice. Anesth Analg. 1995;80(4):764–9. https://doi.org/10.1097/00000539-199504000-00020.CrossRefPubMed

28.

Munoz-Price LS, Lubarsky DA, Arheart KL, Prado G, Cleary T, Fajardo-Aquino Y, et al. Interactions between anesthesiologists and the environment while providing anesthesia care in the operating room. Am J Infect Control. 2013;41(10):922–4. https://doi.org/10.1016/j.ajic.2013.03.306.CrossRefPubMed

29.

Munoz-Price LS, Birnbach DJ, Lubarsky DA, Arheart KL, Fajardo-Aquino Y, Rosalsky M, et al. Decreasing operating room environmental pathogen contamination through improved cleaning practice. Infect Control Hosp Epidemiol. 2012;33(9):897–904. https://doi.org/10.1086/667381.CrossRefPubMed

30.

Fernandez PG, Loftus RW, Dodds TM, Koff MD, Reddy S, Heard SO, et al. Hand hygiene knowledge and perceptions among anesthesia providers. Anesth Analg. 2015;120(4):837–43. https://doi.org/10.1213/ANE.0000000000000408.CrossRefPubMed

31.

Walter CW, Kundsin RB, Harding AL, Page LK. The infector on the surgical team. Clin Neurosurg. 1966;14:361–79. https://doi.org/10.1093/neurosurgery/14.cn_suppl_1.361.CrossRefPubMed

32.

Schaffner W, Lefkowitz LB Jr, Goodman JS, Koenig MG. Hospital outbreak of infections with group a streptococci traced to an asymptomatic anal carrier. N Engl J Med. 1969;280(22):1224–5. https://doi.org/10.1056/nejm196905292802209.CrossRefPubMed

33.

Paul SM, Genese C, Spitalny K. Postoperative group A beta-hemolytic Streptococcus outbreak with the pathogen traced to a member of a healthcare worker's household. Infect Control Hosp Epidemiol. 1990;11(12):643–6. https://doi.org/10.1086/646115.CrossRefPubMed

34.

Loftus RW, Dexter F, Robinson ADM, Horswill AR. Desiccation tolerance is associated with Staphylococcus aureus hypertransmissibility, resistance and infection development in the operating room. J Hosp Infect. 2018;100(3):299–308. https://doi.org/10.1016/j.jhin.2018.06.020.CrossRefPubMed

35.

Dexter F, Elhakim M, Loftus RW, Seering MS, Epstein RH. Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic. J Clin Anesth. 2020;64:109854. https://doi.org/10.1016/j.jclinane.2020.109854.CrossRefPubMedPubMedCentral

36.

Lipp A, Edwards P. Disposable surgical face masks for preventing surgical wound infection in clean surgery. Cochrane Database Syst Rev. 2014;(2):Cd002929. https://doi.org/10.1002/14651858.CD002929.pub2.

37.

Bae S, Kim MC, Kim JY, Cha HH, Lim JS, Jung J, et al. Effectiveness of surgical and cotton masks in blocking SARS-CoV-2: a controlled comparison in 4 patients. Ann Intern Med. 2020. https://doi.org/10.7326/M20-1342.

38.

Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol. 2008;29(11):996–1011. https://doi.org/10.1086/591861.CrossRefPubMed

39.

Beezhold DW, Slaughter S, Hayden MK, Matushek M, Nathan C, Trenholme GM, et al. Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia. Clin Infect Dis. 1997;24(4):704–6. https://doi.org/10.1093/clind/24.4.704.CrossRefPubMed

40.

Hayden MK, Blom DW, Lyle EA, Moore CG, Weinstein RA. Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant enterococcus or the colonized patients' environment. Infect Control Hosp Epidemiol. 2008;29(2):149–54. https://doi.org/10.1086/524331.CrossRefPubMed

41.

Loftus RW, Brown JR, Patel HM, Koff MD, Jensen JT, Reddy S, et al. Transmission dynamics of gram-negative bacterial pathogens in the anesthesia work area. Anesth Analg. 2015;120(4):819–26. https://doi.org/10.1213/ane.0000000000000626.CrossRefPubMed

42.

Bitkover CY, Marcusson E, Ransjö U. Spread of coagulase-negative staphylococci during cardiac operations in a modern operating room. Ann Thorac Surg. 2000;69(4):1110–5. https://doi.org/10.1016/s0003-4975(99)01432-0.CrossRefPubMed

43.

Schweizer ML, Chiang HY, Septimus E, Moody J, Braun B, Hafner J, et al. Association of a bundled intervention with surgical site infections among patients undergoing cardiac, hip, or knee surgery. Jama. 2015;313(21):2162–71. https://doi.org/10.1001/jama.2015.5387.CrossRefPubMed

44.

Lutz CT, Bell CE Jr, Wedner HJ, Krogstad DJ. Allergy testing of multiple patients should no longer be performed with a common syringe. N Engl J Med. 1984;310(20):1335–7. https://doi.org/10.1056/nejm198405173102024.CrossRefPubMed

45.

Fleming A, Ogilvie AC. Syringe needles and mass inoculation technique. Br Med J. 1951;1(4706):543–6. https://doi.org/10.1136/bmj.1.4706.543.CrossRefPubMedPubMedCentral

46.

Koepke JW, Selner JC. Allergy testing of multiple patients with a common syringe. N Engl J Med. 1984;311(18):1188–9. https://doi.org/10.1056/nejm198411013111820.CrossRefPubMed

47.

Blogg CE, Ramsay MA, Jarvis JD. Infection hazard from syringes. Br J Anaesth. 1974;46(4):260–2. https://doi.org/10.1093/bja/46.4.260.CrossRefPubMed

48.

Veber B, Gachot B, Bedos JP, Wolff M. Severe sepsis after intravenous injection of contaminated propofol. Anesthesiology. 1994;80(3):712–3. https://doi.org/10.1097/00000542-199403000-00050.CrossRefPubMed

49.

Kuehnert MJ, Webb RM, Jochimsen EM, Hancock GA, Arduino MJ, Hand S, et al. Staphylococcus aureus bloodstream infections among patients undergoing electroconvulsive therapy traced to breaks in infection control and possible extrinsic contamination by propofol. Anesth Analg. 1997;85(2):420–5. https://doi.org/10.1097/00000539-199708000-00031.CrossRefPubMed

50.

Gutelius B, Perz JF, Parker MM, Hallack R, Stricof R, Clement EJ, et al. Multiple clusters of hepatitis virus infections associated with anesthesia for outpatient endoscopy procedures. Gastroenterology. 2010;139(1):163–70. https://doi.org/10.1053/j.gastro.2010.03.053.CrossRefPubMed

51.

Foweraker JE. The laryngoscope as a potential source of cross-infection. J Hosp Infect. 1995;4. England:315–6.CrossRef

52.

Maslyk PA, Nafziger DA, Burns SM, Bowers PR. Microbial growth on the anesthesia machine. Aana j. 2002;70(1):53–6.PubMed

53.

Olds JW, Kisch AL, Eberle BJ, Wilson JN. Pseudomonas aeruginosa respiratory tract infection acquired from a contaminated anesthesia machine. Am Rev Respir Dis. 1972;105(4):628–32. https://doi.org/10.1164/arrd.1972.105.4.628.CrossRefPubMed

54.

Albrecht WH, Dryden GE. Five-year experience with the development of an individually clean anesthesia system. Anesth Analg. 1974;53(1):24–8.CrossRef

55.

Dryden GE. Risk of contamination from the anesthesia circle absorber: an evaluation. Anesth Analg. 1969;48(6):939–43.CrossRef

56.

Leijten DT, Rejger VS, Mouton RP. Bacterial contamination and the effect of filters in anaesthetic circuits in a simulated patient model. J Hosp Infect. 1992;21(1):51–60. https://doi.org/10.1016/0195-6701(92)90153-d.CrossRefPubMed

57.

Edmiston CE Jr, Seabrook GR, Cambria RA, Brown KR, Lewis BD, Sommers JR, et al. Molecular epidemiology of microbial contamination in the operating room environment: is there a risk for infection? Surgery. 2005;138(4):573–9; discussion 9-82. https://doi.org/10.1016/j.surg.2005.06.045.CrossRefPubMed

58.

van Vlymen JM, Magnus J, Jaeger M, Breton S, Taylor NG, Phelan R, et al. Hepatitis C contamination of medication vials accessed with sterile needles and syringes. Anesthesiology. 2019;131(2):305–14. https://doi.org/10.1097/aln.0000000000002772.CrossRefPubMed

59.

Clark C, Taenzer A, Charette K, Whitty M. Decreasing contamination of the anesthesia environment. Am J Infect Control. 2014;42(11):1223–5. https://doi.org/10.1016/j.ajic.2014.07.016.CrossRefPubMed

60.

Muffly MK, Beach ML, Tong YC, Yeager MP. Stopcock lumen contamination does not reflect the full burden of bacterial intravenous tubing contamination: analysis using a novel injection port. Am J Infect Control. 2010;38(9):734–9. https://doi.org/10.1016/j.ajic.2010.03.014.CrossRefPubMed

61.

Rowlands J, Yeager MP, Beach M, Patel HM, Huysman BC, Loftus RW. Video observation to map hand contact and bacterial transmission in operating rooms. Am J Infect Control. 2014;42(7):698–701. https://doi.org/10.1016/j.ajic.2014.02.021.CrossRefPubMed

62.

Birnbach DJ, Rosen LF, Fitzpatrick M, Carling P, Arheart KL, Munoz-Price LS. A new approach to pathogen containment in the operating room: sheathing the laryngoscope after intubation. Anesth Analg. 2015;121(5):1209–14. https://doi.org/10.1213/ANE.0000000000000854.CrossRefPubMed

63.

Loftus RW, Muffly MK, Brown JR, Beach ML, Koff MD, Corwin HL, et al. Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission. Anesth Analg. 2011;112(1):98–105. https://doi.org/10.1213/ANE.0b013e3181e7ce18.CrossRefPubMed

64.

Siegel JD, Rhinehart E, Jackson M, Chiarello L, Committee HCICPA. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007;35(10):S65–S164.CrossRef

65.

Loftus RW, Patel HM, Huysman BC, Kispert DP, Koff MD, Gallagher JD, et al. Prevention of intravenous bacterial injection from health care provider hands: the importance of catheter design and handling. Anesth Analg. 2012;115(5):1109–19. https://doi.org/10.1213/ANE.0b013e31826a1016.CrossRefPubMed

66.

•• Robinson ADM, Dexter F, Renkor V, Reddy S, Loftus RW. Operating room PathTrac analysis of current intraoperative Staphylococcus aureus transmission dynamics. Am J Infect Control. 2019;47(10):1240–7. https://doi.org/10.1016/j.ajic.2019.03.028 This prospective cohort study linked the risk of exposure to Staphylococcus aureus to patients skin sites and provider hand, highlighting the importance of both patient decolonization as well as provider hand hygiene.CrossRefPubMed

67.

Dexter F, Epstein RH, Gostine AL, Penning DH, Loftus RW. Benefit of systematic selection of pairs of cases matched by surgical specialty for surveillance of bacterial transmission in operating rooms. Am J Infect Control. 2019;48:682–7. https://doi.org/10.1016/j.ajic.2019.09.025.CrossRefPubMed

68.

Pavia M, Simpser E, Becker M, Mainquist WK, Velez KA. The effect of ultraviolet-C technology on viral infection incidence in a pediatric long-term care facility. Am J Infect Control. 2018;46(6):720–2. https://doi.org/10.1016/j.ajic.2018.01.014.CrossRefPubMed

69.

Andersen BM, Bånrud H, Bøe E, Bjordal O, Drangsholt F. Comparison of UV C light and chemicals for disinfection of surfaces in hospital isolation units. Infect Control Hosp Epidemiol. 2006;27(7):729–34. https://doi.org/10.1086/503643.CrossRefPubMed

70.

Schweizer M, Perencevich E, McDanel J, Carson J, Formanek M, Hafner J, et al. Effectiveness of a bundled intervention of decolonization and prophylaxis to decrease Gram positive surgical site infections after cardiac or orthopedic surgery: systematic review and meta-analysis. Bmj. 2013;346:f2743. https://doi.org/10.1136/bmj.f2743.CrossRefPubMedPubMedCentral

71.

Vasquez JE, Walker ES, Franzus BW, Overbay BK, Reagan DR, Sarubbi FA. The epidemiology of mupirocin resistance among methicillin-resistant Staphylococcus aureus at a Veterans' Affairs hospital. Infect Control Hosp Epidemiol. 2000;21(7):459–64. https://doi.org/10.1086/501788.CrossRefPubMed

72.

Anderson MJ, David ML, Scholz M, Bull SJ, Morse D, Hulse-Stevens M, et al. Efficacy of skin and nasal povidone-iodine preparation against mupirocin-resistant methicillin-resistant Staphylococcus aureus and S. aureus within the anterior nares. Antimicrob Agents Chemother. 2015;59(5):2765–73. https://doi.org/10.1128/aac.04624-14.CrossRefPubMedPubMedCentral

73.

Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605–27. https://doi.org/10.1086/676022.CrossRefPubMedPubMedCentral

74.

• Loftus RW, Dexter F, Parra MC, Brown JR. Importance of oral and nasal decontamination for patients undergoing anesthetics during the COVID-19 era. Anesth Analg. 2020. https://doi.org/10.1213/ANE.0000000000004854 This paper discusses the favorable risk/benefit profile of patient decolonization with nasal povidone and oral chlorhexidine rinse to help mitigate the perioperative spread of COVID-19.

75.

Chapman AK, Aucott SW, Milstone AM. Safety of chlorhexidine gluconate used for skin antisepsis in the preterm infant. J Perinatol. 2012;32(1):4–9. https://doi.org/10.1038/jp.2011.148.CrossRefPubMed

76.

Murrell LJ, Hamilton EK, Johnson HB, Spencer M. Influence of a visible-light continuous environmental disinfection system on microbial contamination and surgical site infections in an orthopedic operating room. Am J Infect Control. 2019;47(7):804–10. https://doi.org/10.1016/j.ajic.2018.12.002.CrossRefPubMed

77.

Anderson DJ, Gergen MF, Smathers E, Sexton DJ, Chen LF, Weber DJ, et al. Decontamination of targeted pathogens from patient rooms using an automated ultraviolet-C-emitting device. Infect Control Hosp Epidemiol. 2013;34(5):466–71. https://doi.org/10.1086/670215.CrossRefPubMedPubMedCentral

Title: Perioperative Infection Transmission: the Role of the Anesthesia Provider in Infection Control and Healthcare-Associated Infections
Authors: Archit Sharma
Patrick G. Fernandez
John P. Rowlands
Matthew D. Koff
Randy W. Loftus
Publication date: 01-09-2020
Publisher: Springer US
Keyword: COVID-19
Published in: Current Anesthesiology Reports / Issue 3/2020
Electronic ISSN: 2167-6275
DOI: https://doi.org/10.1007/s40140-020-00403-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Perioperative Infection Transmission: the Role of the Anesthesia Provider in Infection Control and Healthcare-Associated Infections

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 3/2020

The Multiple Casualty Scenario: Role of the Anesthesiologist

Perioperative Bridging/Cessation of Antiplatelet Agents: 2020 Update

Appropriate Use of Neuromuscular Blocking Agents and Reversal Drugs to Enhance Recovery Following Cardiac Surgery

History and Practice of Acute Normovolemic Hemodilution

Physician Burnout: Achieving Wellness for Providers and Patients

Review of Current Practices of Peripheral Nerve Blocks for Hip Fracture and Surgery