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Tostes LCS, Loyola ABAT, Fraga ADEO, Gazzi LA, Paiva LFDE, Juliano Y, Veiga DF. Alcohol (70%) versus alcoholic chlorhexidine solution (0.5%) in skin antisepsis for neuraxial blocks: a randomized clinical trial. Rev Col Bras Cir 2021; 48:e20202633. [PMID: 33470369 PMCID: PMC10683467 DOI: 10.1590/0100-6991e-20202633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to compare the use of 0.5% alcoholic chlorhexidine and 70% alcohol in skin antisepsis for neuraxial blocks. METHOD this is a non-inferiority randomized clinical trial, with two parallel arms. Seventy patients who were candidates for neuraxial block were randomly allocated to group A (n = 35), in whom antisepsis was performed with 0.5% alcoholic chlorhexidine, or to group B (n = 35), in whom we used 70% hydrated ethyl alcohol. Swabs were harvested for culture at three times: before antisepsis, two minutes after application of the antiseptic, and immediately after puncture. The samples were sown in three culture media and the number of colony forming units (CFU) per cm² was counted. RESULTS there was no difference between the groups regarding age, sex, body mass index, time to perform the block or type of block. There were no differences between groups in the CFU/cm² counts before antisepsis. There was less bacterial growth in group B two minutes after application of the antiseptic (p = 0.048), but there was no difference between the groups regarding the number of CFU/cm² at the end of the puncture. CONCLUSION 70% alcohol was more effective in reducing the number of CFU/cm² after two minutes, and there was no difference between the two groups regarding skin colonization at the end of the procedure. These results suggest that 70% alcohol may be an option for skin antisepsis before neuraxial blocks. Trial registration: ClinicalTrials.gov, NCT02833376.
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Affiliation(s)
- Luiz Carlos Souza Tostes
- - Universidade do Vale do Sapucaí (UNIVÁS), Mestrado Profissional em Ciências Aplicadas à Saúde - Pouso Alegre - MG - Brasil
| | - Ana Beatriz Alkmim Teixeira Loyola
- - Universidade do Vale do Sapucaí (UNIVÁS), Mestrado Profissional em Ciências Aplicadas à Saúde - Pouso Alegre - MG - Brasil
- - Universidade do Vale do Sapucaí (UNIVÁS), Departamento de Farmácia - Pouso Alegre - MG - Brasil
- - Universidade do Vale do Sapucaí (UNIVÁS), Disciplina de Microbiologia - Pouso Alegre - MG - Brasil
| | - Adilson DE Oliveira Fraga
- - Universidade do Vale do Sapucaí (UNIVÁS), Mestrado Profissional em Ciências Aplicadas à Saúde - Pouso Alegre - MG - Brasil
- - Hospital e Maternidade Santa Paula, Programa de Residência Médica em Anestesiologia - Pouso Alegre - MG - Brasil
| | - LetÍcia Azevedo Gazzi
- - Universidade do Vale do Sapucaí (UNIVÁS), Faculdade de Medicina - Pouso Alegre - MG - Brasil
| | - Luiz Francisley DE Paiva
- - Universidade do Vale do Sapucaí (UNIVÁS), Mestrado Profissional em Ciências Aplicadas à Saúde - Pouso Alegre - MG - Brasil
- - Universidade do Vale do Sapucaí (UNIVÁS), Disciplina de Microbiologia - Pouso Alegre - MG - Brasil
| | - Yara Juliano
- - Universidade do Vale do Sapucaí (UNIVÁS), Mestrado Profissional em Ciências Aplicadas à Saúde - Pouso Alegre - MG - Brasil
- - Universidade Santo Amaro (UNISA), Disciplina de Bioestatística - Santo Amaro - SP - Brasil
- - Universidade do Vale do Sapucaí (UNIVÁS), Disciplina de Bioestatística - Pouso Alegre - MG - Brasil
| | - Daniela Francescato Veiga
- - Universidade do Vale do Sapucaí (UNIVÁS), Mestrado Profissional em Ciências Aplicadas à Saúde - Pouso Alegre - MG - Brasil
- - Universidade Federal de São Paulo (UNIFESP), Programa de Pós-graduação em Cirurgia Translacional - São Paulo - SP - Brasil
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Teunissen AJW, Koning MV, Ruijgrok EJ, Liefers WJ, de Bruijn B, Koopman SA. Measurement of drug concentration and bacterial contamination after diluting morphine for intrathecal administration: an experimental study. BMC Anesthesiol 2020; 20:244. [PMID: 32977744 PMCID: PMC7517689 DOI: 10.1186/s12871-020-01151-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022] Open
Abstract
Background Low concentrations of morphine are required for safe dosing for intrathecal injections. Sometimes, manual dilution of morphine is performed to achieve these low concentrations, but risks dilution errors and bacterial contamination. The primary goal was to compare the concentrations of morphine and bupivacaine between four groups of syringes. The secondary goal was to investigate the difference in contamination rate between these groups. Methods Twenty-five experienced anesthesia providers were asked to prepare a mixture of bupivacaine 2.0 mg/ml and morphine 60 μg/ml using 3 different methods as clean and precise as possible. The fourth method used was the aspiration of ampoules prepared by the pharmacy. The concentrations of morphine and bupivacaine were measured by High-Pressure Liquid Chromatography (HPLC). The medication was cultured for bacterial contamination. Results Group 1 (median 60 μg/ml; 95% CI: 59–110 μg/ml) yielded 3 outliers above 180 μg/ml morphine concentration. Group 2 (76 μg/ml; 95% CI: 72–80 μg/ml) and 3 (69 μg/ml; 95% CI: 66–71 μg/ml) were consistently higher than the target concentration of 60 μg. The group “pharmacy” was precise and accurate (59 μg/ml; 95% CI: 59–59 μg/ml). Group 2 and “pharmacy” had one contaminated sample with a spore-forming aerobic gram-positive rod. Conclusion Manually diluted morphine is at risk for deviating concentrations, which could lead to increased side-effects. Medication produced by the hospital pharmacy was highly accurate. Furthermore, even when precautions are undertaken, contamination of the medication is a serious risk and appeared to be unrelated to the dilution process.
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Affiliation(s)
- Aart Jan W Teunissen
- Anesthesiology, Maasstadziekenhuis, Maasstadweg 21, 3079DZ, Rotterdam, The Netherlands.
| | - Mark V Koning
- Anesthesiology, Rijnstate hospital, Arnhem, The Netherlands
| | - Elisabeth J Ruijgrok
- Pharmacy, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
| | | | - Bart de Bruijn
- Anesthesiology, Maasstadziekenhuis, Maasstadweg 21, 3079DZ, Rotterdam, The Netherlands
| | - Seppe A Koopman
- Anesthesiology, Maasstadziekenhuis, Maasstadweg 21, 3079DZ, Rotterdam, The Netherlands
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Azi LMTDA, Fonseca NM, Linard LG. SBA 2020: Regional anesthesia safety recommendations update. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32636024 PMCID: PMC9373527 DOI: 10.1016/j.bjane.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of the Brazilian Society of Anesthesiology (SBA)’s Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.
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Affiliation(s)
- Liana Maria Tôrres de Araújo Azi
- Universidade Federal da Bahia (UFBA), Departamento de Anestesiologia e Cirurgia, Salvador, BA, Brazil; Hospital Universitário Professor Edgard Santos, Centro de Ensino e Treinamento em Anestesiologia, Salvador, BA, Brazil; Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil.
| | - Neuber Martins Fonseca
- Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Disciplina de Anestesiologia, Uberlândia, MG, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Centro de Ensino e Treinamento em Anestesiologia, Uberlândia, MG, Brazil; Coordinator of the Comitê de Estudo de Equipamentos Respiratórios e de Anestesiologia da ABNT, and Delegate and representative of the SBA Board at the Technical Committee 121/ISO - Anesthetic and Respiratory Equipment, Uberlândia, MG, Brazil
| | - Livia Gurgel Linard
- Hospital Geral do Estado 2 and of Hospital Roberto Santos, Salvador, BA, Brazil
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Azi LMTDA, Fonseca NM, Linard LG. [SBA 2020: Regional anesthesia safety recommendations update]. Rev Bras Anestesiol 2020; 70:398-418. [PMID: 32636024 DOI: 10.1016/j.bjan.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/26/2020] [Accepted: 02/08/2020] [Indexed: 12/24/2022] Open
Abstract
The purpose of the Brazilian Society of Anesthesiology's (SBA) Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.
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Affiliation(s)
- Liana Maria Tôrres de Araújo Azi
- Universidade Federal da Bahia (UFBA), Departamento de Anestesiologia e Cirurgia, Salvador, BA, Brazil; Hospital Universitário Professor Edgard Santos, Centro de Ensino e Treinamento em Anestesiologia, Salvador, BA, Brazil; Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil.
| | - Neuber Martins Fonseca
- Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Disciplina de Anestesiologia, Uberlândia, MG, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Centro de Ensino e Treinamento em Anestesiologia, Uberlândia, MG, Brazil; Coordinator of the Comitê de Estudo de Equipamentos Respiratórios e de Anestesiologia da ABNT, and Delegate and representative of the SBA Board at the Technical Committee 121/ISO - Anesthetic and Respiratory Equipment, Uberlândia, MG, Brazil
| | - Livia Gurgel Linard
- Hospital Geral do Estado 2 and of Hospital Roberto Santos, Salvador, BA, Brazil
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The Role of the Anesthesiologist in Preventing Severe Maternal Morbidity and Mortality. Clin Obstet Gynecol 2018; 61:372-386. [DOI: 10.1097/grf.0000000000000350] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fayman K, Allan A, Hudson C, Logarta M. A survey of international antisepsis procedures for neuraxial catheterisation in labour. Int J Obstet Anesth 2017; 33:8-16. [PMID: 29295779 DOI: 10.1016/j.ijoa.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/26/2017] [Accepted: 10/01/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neuraxial analgesia during labour is a mainstay of anaesthetic practice globally. Despite the potential for significant neurological and infectious complications, international antisepsis practices for neuraxial anaesthesia vary widely. AIMS The primary aim of this study was to clarify international antisepsis practices prior to neuraxial analgesia in labour. The secondary aim was to determine an approximate international incidence of neuraxial infections and neurological complications secondary to neuraxial analgesia techniques in labour. MATERIALS AND METHODS Heads of Departments of Anaesthesiology were invited to complete an online questionnaire exploring antisepsis practices and complications of neuraxial catheterisation. Data from 151 institutions in 13 countries were collected over 11months. RESULTS Data were collected for an estimated 6008540 deliveries and 3770800 neuraxial catheterisations. The average annual birth rate per institution was 3979 births, with an average of 2497 neuraxial catheterizations (representing 62.8% of deliveries). Forty-nine percent of responders reported always wearing sterile gowns for the procedure, whereas 47.7% never wear gowns. Chlorhexidine was used by 88.1% of those surveyed, and 96.7% always wore facemasks. Thirty-four percent of institutions reported infectious complications over a 10-year period. Ninety neuraxial infections were estimated, giving an approximate incidence of 1:41898 catheterisations (2.39 infections per 100000 catheterisations). A total of 202 neurological complications were reported, with an approximate incidence of 1:18667 catheterisations (5.36 neurological complications per 100000 catheterisations). CONCLUSION The survey demonstrated marked variation in aseptic practice between both responding centres and countries. The incidence of infectious and neurological complications secondary to neuraxial catherisation in labour has been approximated.
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Affiliation(s)
- K Fayman
- Department of Anaesthesia, Campbelltown Hospital, Therry Road, Campbelltown, New South Wales 2560, Australia
| | - A Allan
- Department of Anaesthesia, Campbelltown Hospital, Therry Road, Campbelltown, New South Wales 2560, Australia
| | - C Hudson
- Department of Anaesthesia, Campbelltown Hospital, Therry Road, Campbelltown, New South Wales 2560, Australia
| | - M Logarta
- Department of Anaesthesia, Campbelltown Hospital, Therry Road, Campbelltown, New South Wales 2560, Australia.
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Mustroph CM, Malcolm JG, Rindler RS, Chu JK, Grossberg JA, Pradilla G, Ahmad FU. Cranioplasty Infection and Resorption Are Associated with the Presence of a Ventriculoperitoneal Shunt: A Systematic Review and Meta-Analysis. World Neurosurg 2017; 103:686-693. [DOI: 10.1016/j.wneu.2017.04.066] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 04/07/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
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Practice Advisory for the Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Techniques. Anesthesiology 2017; 126:585-601. [DOI: 10.1097/aln.0000000000001521] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Supplemental Digital Content is available in the text.
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De Luigi AJ, Kennedy DJ. Safety Implications for Lumbar Epidural Injections: Caudal, Interlaminar, and Transforaminal Approaches. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0116-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Meta-analysis of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents: causative organisms and possible prevention strategies. Retina 2011; 31:654-61. [PMID: 21330939 DOI: 10.1097/iae.0b013e31820a67e4] [Citation(s) in RCA: 295] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the rates of endophthalmitis and the spectrum of causative organisms after intravitreal injection of anti-vascular endothelial growth factor agents and possible prevention strategies. METHODS Meta-analysis of the U.S. literature from 2005 to 2009 reporting endophthalmitis bacterial isolates after intravitreal injection of anti-vascular endothelial growth factor agents and comparison with reports of endophthalmitis bacterial isolates after intraocular surgery in the United States. RESULT Endophthalmitis after intravitreal injection occurred in 52 of 105,536 injections (0.049%) (95% confidence interval [CI], 0.038-0.065%). Among 50 cases of endophthalmitis with bacterial culture isolates, 24 (48.0% [95% CI, 34.8-61.5%]) were culture negative and 26 (52% [95% CI, 38.5-65.2%]) were culture positive. Among the 26 culture-positive isolates, causative organisms were coagulase-negative Staphylococcus in 17 cases (65.4% [95% CI, 46.0-80.6%]), Streptococcus species in 8 cases (30.8% [95% CI, 16.5-50.2%]), and Bacillus cereus in 1 case (3.8% [95% CI, 0.9-19.0%]). Streptococcus species were significantly more frequent after intravitreal injection than after intraocular surgery in the Endophthalmitis Vitrectomy Study (29 of 226 isolates, 9.0% [95% CI, 6.3-12.6%], P = 0.005), a report on clear corneal cataract surgery endophthalmitis (6 of 73 isolates, 8.2% [95% CI, 3.9-16.8%], P = 0.022), and a report on postvitrectomy endophthalmitis with no cases of Streptococcus species. CONCLUSION Streptococcal isolates are approximately three times more frequent after intravitreal anti-vascular endothelial growth factor injection than after intraocular surgery. Strategies to consider minimizing oropharyngeal droplet transmission may include avoiding talking, coughing, and sneezing or wearing surgical masks.
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Sharma B, Gupta S, Jain N, Handoo A, Sood J. Cerebrospinal fluid cytology in patients undergoing combined spinal epidural versus spinal anaesthesia without an introducer. Anaesth Intensive Care 2011; 39:914-8. [PMID: 21970139 DOI: 10.1177/0310057x1103900518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The problem of tissue coring exists despite the availability of smaller gauge spinal needles with special tip designs. The aim of the study was to test the hypotheses that a) subarachnoid block given as a part of a combined spinal epidural intervention by needle-through-needle technique introduces a lesser number of epithelial cells into the subarachnoid space compared to isolated subarachnoid block, and b) after lumbar puncture, the initial few drops of cerebrospinal fluid from the spinal needle will have a higher number of epithelial cells than the subsequent sample. One hundred and seven patients of American Society of Anesthesiologists physical status I to III undergoing infra-umbilical surgery were enrolled. Seven patients were excluded from the study and the rest divided into two groups to receive either combined spinal epidural anaesthesia (group A) or isolated subarachnoid anaesthesia, unaided by an introducer (group B). The two groups were compared for the presence of epithelial cells in cerebrospinal fluid. The initial four to six drops of cerebrospinal fluid (sample 1) were collected, the next four to six drops discarded and the following four to six drops (sample 2) collected. The incidence of coring was 96% in group A and 88% in group B (P = 0.142). The median (interquartile range) number of cells in group A, for samples 1 and 2 was 6 (3 to 12.5) and 6 (3 to 10); and in group B, 3.5 (1 to 10) and 4 (1 to 8) respectively. Significant tissue coring was observed with both techniques. Discarding eight to 12 drops of cerebrospinal fluid did not help in reducing the epithelial cell load.
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Affiliation(s)
- B Sharma
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, India.
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Fernandes CR, Fonseca NM, Rosa DM, Simões CM, Duarte NMDC. Brazilian Society of Anesthesiology Recommendations for Safety in Regional Anesthesia. Rev Bras Anestesiol 2011; 61:668-94, 366-81. [DOI: 10.1016/s0034-7094(11)70077-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Description of nosocomial infection prevention practices by anesthesiologists in a university hospital. Rev Bras Anestesiol 2011; 61:177-81, 182-7, 95-100. [PMID: 21474025 DOI: 10.1016/s0034-7094(11)70022-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 09/09/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Anesthesiologists play an important role in the prevention of nosocomial infections. In anesthetic practice, physiologic barriers are routinely breached, allowing patient contamination with microorganisms and the consequent development of infection. The lack of adhesion to recommended practices can facilitate transmission of microorganisms. It is important to describe prophylactic practices of anesthesia-related nosocomial infections performed by anesthesiologists. METHODS Structured questionnaires were distributed to be answered voluntarily and anonymously by anesthesiologists. RESULTS Among 112 anesthesiologists, 75% answered the questionnaire. Surgical mask is used by 95.2% of anesthesiologists, 96.3% wear gloves frequently, 98.9% wear sterile gloves for neuraxial block, 91.3% use sterile technique for central venous puncture, 95.1% wash their hands between cases, 91.6% try to maintain the endotracheal tube sterile, 96.3% discard the prefilled propofol syringe at the end of each anesthesia, 30% clean the vials before using it in the neuraxial blocks, and 19.8% clean the vials before intravenous use. CONCLUSIONS Respondents showed good adhesion to practices of nosocomial infection prophylaxis and to improve them educational multidisciplinary campaigns are necessary.
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Aldrete JA. Arachnoiditis and Related Conditions. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00093-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Morgan G. Microbial growth in a mixture of hyperbaric bupivacaine and fentanyl prepared in a multi-dose syringe in the operating theatre environment. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2010. [DOI: 10.1080/22201173.2010.10872661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Intraspinal techniques for pain management in cancer patients: a systematic review. Support Care Cancer 2009; 18:137-49. [DOI: 10.1007/s00520-009-0784-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 11/09/2009] [Indexed: 10/20/2022]
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Abstract
A 37-y-old male was admitted to the ICU because of meningitis and respiratory failure with epileptic seizures. Spinal fluid grew Streptococcus salivarius. Prior to presentation the patient underwent surgical excision of a chronic toe ulcer, performed under spinal anaesthesia, which raised the suspicion of iatrogenic origin of the disease. The clinical situation deteriorated over the following d and the patient died from multi-organ failure. Careful hygiene measures are needed to prevent such a severe complication.
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Affiliation(s)
- Teysir Halaby
- Laboratory for Medical Microbiology and Public Health, Enschede, The Netherlands
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Merriman S, Paech MJ, Keil AD. Bacterial Contamination in Solution Aspirated from Non-Sterile Packaged Fentanyl Ampoules: A Laboratory Study. Anaesth Intensive Care 2009; 37:608-12. [DOI: 10.1177/0310057x0903700413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Iatrogenic meningitis is a rare complication of spinal anaesthesia. It is mandatory to use a technique which minimises the risk of introducing bacteria into the subarachnoid space. Currently available fentanyl ampoules require a careful drawing-up technique, as the outside of the ampoule is not sterile and there is potential to contaminate the contents in the drawing-up process. We designed a pilot laboratory study to determine the extent of bacterial contamination of fentanyl solutions drawn up from non-sterile packaged glass fentanyl ampoules using three different methods: aspirating through a 5 μm filter needle only, aspirating through a 5 μm filter needle after swabbing the neck of the ampoule with isopropyl alcohol and aspirating through an antibacterial filter in addition to the 5 μm filter needle. Ten anaesthetists used each method once, in randomised order, to draw up solution from three different fentanyl ampoules. Samples underwent bacterial culture in blood agar and enrichment broth for 48 hours. No significant growth was seen in any sample. This pilot study did not identify any bacterial contamination of fentanyl solution irrespective of which of the three methods for aspiration was used.
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Affiliation(s)
- S. Merriman
- Departments of Anaesthesia and Pain Medicine and Microbiology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
- Anaesthesia Registrar, Department of Anaesthesia and Pain Medicine
| | - M. J. Paech
- Departments of Anaesthesia and Pain Medicine and Microbiology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
- Professor of Obstetric Anaesthesia, The School of Medicine and Pharmacology, The University of Western Australia, Perth
| | - A. D. Keil
- Departments of Anaesthesia and Pain Medicine and Microbiology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
- Head, Department of Microbiology, PathWest Laboratory Medicine, King Edward Memorial Hospital
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Videira RLR. Nosocomial infections and infection control in regional anesthesia. Acta Anaesthesiol Scand 2009; 53:546. [PMID: 19317869 DOI: 10.1111/j.1399-6576.2008.01854.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Iatrogenic Meningitis in an Obstetric Patient After Combined Spinal-Epidural Analgesia: Case Report and Review of the Literature. South Med J 2009; 102:287-90. [DOI: 10.1097/smj.0b013e318198696a] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Horlocker TT, Wedel DJ. Infectious complications of regional anesthesia. Best Pract Res Clin Anaesthesiol 2008; 22:451-75. [DOI: 10.1016/j.bpa.2008.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Infection is the commonest cause of serious neurologic sequelae of neuraxial anesthesia. The incidence depends on operator skill and patient population. Meningitis, a complication of dural puncture, is usually caused by viridans streptococci. The risk factors are dural puncture during labor, no mask and poor aseptic technique, vaginal infection and bacteremia. Epidural abscess is a complication of epidural catheterization, route of entry the catheter track and the organism usually the staphylococcus. Principal risk factors are prolonged catheterization, poor aseptic technique and traumatic insertion. Prevention includes wearing a mask, using a full sterile technique, avoiding prolonged catheterization and prescribing antibiotics in a high-risk situation.
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Rubin L, Sprecher H, Kabaha A, Weber G, Teitler N, Rishpon S. Meningitis following spinal anesthesia: 6 cases in 5 years. Infect Control Hosp Epidemiol 2007; 28:1187-90. [PMID: 17828697 DOI: 10.1086/520748] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 05/09/2007] [Indexed: 11/03/2022]
Abstract
We describe 6 cases of meningitis after spinal anesthesia associated with a single anesthesiologist over the course of 5 years. The earliest case occurred in 2000, and the other 5 cases occurred over the course of 14 months in 2004-2005. The case identified in 2000 was culture-positive for Streptococcus salivarius. The other 5 cases were culture-negative for this organism but in 2 cases, the cerebrospinal fluid was found to be positive for bacterial DNA that was identified as belonging to S. salivarius by sequencing of the 16S rRNA gene. The association with a single anesthesiologist and a single hospital during a relatively short interval, however, lead us to believe that these occurrences are part of a series associated with possible violations of aseptic technique.
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Affiliation(s)
- Lisa Rubin
- Haifa District Health Office, Haifa, Israel.
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Rodrigo N, Perera KNT, Ranwala R, Jayasinghe S, Warnakulasuriya A, Hapuarachchi S. Aspergillus meningitis following spinal anaesthesia for caesarean section in Colombo, Sri Lanka. Int J Obstet Anesth 2007; 16:256-60. [PMID: 16945517 DOI: 10.1016/j.ijoa.2006.06.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2006] [Indexed: 10/24/2022]
Abstract
We report six cases of Aspergillus meningitis after spinal anaesthesia for caesarean section administered in June and July 2005. Three patients died before a fungal infection was confirmed at the first post-mortem examination in August. Thereafter anti-fungal therapy was successful in saving the lives of the other three patients. Some syringes and spinal needles supplied to the hospitals concerned were found to be contaminated with Aspergillus fumigatus. Investigators found that medical supply storage facilities were substandard following the influx of donations after the tsunami of December 2004.
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26
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Blasco-Navalpotro MA, Ramos-Luengo A, Rodríguez-Roldán JM, Heras-La Calle G. [Pneumococcal meningitis following spinal anesthesia]. Enferm Infecc Microbiol Clin 2007; 25:164. [PMID: 17288919 DOI: 10.1016/s0213-005x(07)74252-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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28
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Abstract
In spinal anaesthesia, surgical analgesia and in most cases motor block is achieved by injecting one or more drugs into the cerebrospinal fluid. As one of the earliest methods of anaesthesia it was introduced into clinical practice in the late nineteenth century. Although later on it was more or less replaced by "modern" general anaesthesia, it has regained popularity due to its benefits for certain patient populations. In spite of being a technically simple procedure, performing spinal anaesthesia requires a sound knowledge of applied physiology and pharmacology, especially in high-risk groups such as pregnant women or former preterm babies. For some patients even under anticoagulant therapy, spinal anaesthesia might be the best option, considering the individual risk of alternative methods.
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Affiliation(s)
- F Gerheuser
- Klinik für Anästhesiologie und Operative Intensivmedizin, Zentralklinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg.
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29
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Kalaycý M, Cadavi F, Altunkaya H, Gül S, Ackgöz B. Subdural empyema due to spinal anesthesia. Acta Anaesthesiol Scand 2005; 49:426. [PMID: 15752418 DOI: 10.1111/j.1399-6576.2005.00652.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Hwang BM, Leem JG. Aseptic Meningitis after a Lumbar Epidural Steroid Injection -A case report-. Korean J Pain 2005. [DOI: 10.3344/kjp.2005.18.1.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Byeong Mun Hwang
- Department of Anesthesiology and Pain Management, College of Medicine, University of Ulsan, Seoul Asan Medical Center, Seoul, Korea
| | - Jung Gil Leem
- Department of Anesthesiology and Pain Management, College of Medicine, University of Ulsan, Seoul Asan Medical Center, Seoul, Korea
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32
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Hodgson RE. To the Editor. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2004. [DOI: 10.1080/22201173.2004.10872352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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33
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Videira RLR. Aseptic practice and neuraxial blockade. Anaesthesia 2002; 57:1233-4. [PMID: 12437744 DOI: 10.1046/j.1365-2044.2002.02913_33.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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