CME Module 12: Aseptic Technique and Septic Complications of Regional Anesthesia Next >

 

Introduction

 

Beginning in the 19th century, knowledge was acquired that bacteria were a causative agent in the transmission and development of disease. From that knowledge sprang the development of various infection control measures designed to reduce the transmission of organisms between patients and between hospital personnel. In addition, the principles and methods of practicing sterile technique were developed, the primary purpose of which is the exclusion of all microorganisms.1

Within the health care profession, nursing schools have incorporated training on the principals and practices of infection control and sterile technique within the curriculum. Not so in the medical profession. Doctors often learn aseptic technique in a rather “hit and miss” fashion and often lack formal structured teaching in regards to the principles of asepsis2, 3. While most appreciate the obvious requirements of gowns, gloves, masks and skin preparation for sterility, the less obvious principles of asepsis are frequently not well taught.

One of the purposes of this module is to review the basic principals of asepsis in regards to the performance of regional anesthesia, specifically in relation to epidural and spinal blockade. While some may question the need for such training on the belief that infections secondary to neuraxial anesthesia are very rare, more recent data suggests that this may not be the case. In a recent editorial, Reynolds4 noted that in the United States, infection is the commonest cause of neuraxial injury claims in the obstetrical population. Moreover, she states that infection is even more common in the nonobstetrical population. Although the true incidence of epidural abscess or meningitis in either population is not known, rates as high as 1:800 have been reported5. In addition, many cases do not get reported as they are often associated with litigation.

In 2004, the American Society of Regional Anesthesia (ASRA) recognized that historically little attention has been paid to the risk of neuroaxial infection in relation to regional anesthesia, that infection is the most common cause of neuroaxial claims in the obstetrical population in the USA, and that infection is even more common in the nonobstetrical population. Consequently, they held a consensus conference in order to develop a set of aseptic practice guidelines, based on expert consensus and the available literature6-9. Included in these guidelines were issues related to regional anesthesia in febrile or infected patients as well as in immunocompromised patients. They also addressed the importance and implications of aseptic techniques during regional anesthesia.

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