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Chapter 15. Infection Control in Regional Anesthesia

What is true about the epidemiology of infections related to regional anesthesia?

A. E. coli is the predominant pathogen for infections related to regional anesthesia.

B. Microorganisms from the oral cavity of the patient are a predominant source of infections associated with epidural catheters.

C. Epidural catheters inserted for long-term pain control become infected more frequently than those used for short periods of time.

D. Younger males undergoing hip replacement surgery are at an especially high risk for epidural catheter–associated infections.

E. Severe sequelae of infected neuraxial catheters are so infrequent, that case reports in the literature are missing.

C is correct. In general, epidural catheters inserted for long-term pain control become infected more frequently than those used for short periods of time. Du Pen and associates identified 30 superficial (9.3/10,000 catheter-days), 8 deep catheter track (2.5/10,000 catheter-days), and 15 epidural space (4.6/10,000 catheter-days) infections among 350 patients who had long-term epidural catheters.1 Similarly, Zenz and colleagues identified two cases of meningitis among 139 patients (1.4%, or 2.1/10,000 catheter-days) treated for pain due to malignancy.2 Coombs reported that 10 of 92 (10.9%) cancer patients acquired local infections, and 2 (2.2%) acquired meningitis.3

A is incorrect. Streptococcal species, S. aureus, and Pseudomonas aeruginosa are the most common causative agents but multiresistant species also emerge as causative pathogens as their endemic impact grows within health-care systems.

B is incorrect. Microorganisms from the patient’s or anesthesia practitioner’s flora can be inoculated directly when a catheter or needle is inserted into the epidural or subarachnoid space.

D is incorrect. Malignancy and reduced immunocompetence might be risk factors for catheter infection, but young age is not.

E is incorrect. Case reports of infections occurring after epidural neuraxial blockade point out that complications from infection can be severe and often lead to epidural or intraspinal abscesses.

Which infection control measures are important?

A. The patient needs to wear a mask during placement of an epidural catheter for labor and delivery.

B. A sterile gown should be worn during insertion of epidural or nerve block catheters.

C. A fresh unsterile glove should be used to cover an ultrasound probe used for real-time needle guidance.

D. There is no valid surveillance method for regional analgesia catheter-related infections.

E. Use of 1% povidone-iodine is recommended for skin disinfection before spinal anesthesia.

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