[Prevention of postoperative surgical wound infection: recommendations of the Hospital Hygiene and Infection Prevention Committee of the Robert Koch Institute]

Nosocomial infections and infection control in regional anesthesia

BACKGROUND

Although rare, infectious complications from regional anesthesia and analgesia can be devastating. The literature on this topic consists primarily of surveys, case reports, case series, and studies in which used supplies were cultured. We derived infection control recommendations from the existing literature and compared these recommendations with existing guidelines.

METHODS

Structured literature search of the Cochrane Central Register of Controlled Trials, MEDLINE, including old MEDLINE and EMBASE until 2005. Descriptive statistics were cited when applicable.

MAIN RESULTS

Incidence rates for infectious complications vary substantially between studies and range from 3.7 to 7.2/100,000 for spinal anesthesia-associated meningitis and from 0.2 to 83/100,000 for epidural anesthesia-associated epidural abscesses. Few comprehensive prospective trials have been conducted and most case reports do not provide complete information about infection control practices.

CONCLUSION

Studies using more robust methods are necessary to define the rates of infection after different regional anesthesia procedures and to identify risk factors for infections. Data on risk factors would allow anesthesiologists to develop evidence-based guidelines for placement and care of catheters used for regional anesthesia. A multicenter surveillance system may help anesthesiologists address some of the unanswered questions and to develop evidence-based infection control recommendations.

[Prevention of nosocomial infections]

Nosocomial infections are still an important issue in surgical wards. About one patient in 15 is affected, most of them from surgical site or urinary tract infections, but pneumonia cases can also be observed frequently. Some of these infections are due to multiresistant pathogens. About one third of nosocomial infections can be regarded as avoidable. Routine surveillance of nosocomial infections and multiresistant pathogens, feedback of data to all personnel involved in patient care, and routine educational activities in this field are the crucial elements for achieving high compliance with the most important infection control measures.