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Chapter 15. Infection Control in Regional Anesthesia
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What is true about the epidemiology of infections related to regional anesthesia?
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A. E. coli is the predominant pathogen for infections related to regional anesthesia.
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B. Microorganisms from the oral cavity of the patient are a predominant source of infections associated with epidural catheters.
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C. Epidural catheters inserted for long-term pain control become infected more frequently than those used for short periods of time.
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D. Younger males undergoing hip replacement surgery are at an especially high risk for epidural catheter–associated infections.
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E. Severe sequelae of infected neuraxial catheters are so infrequent, that case reports in the literature are missing.
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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
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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.
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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.
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D is incorrect. Malignancy and reduced immunocompetence might be risk factors for catheter infection, but young age is not.
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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.
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Which infection control measures are important?
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A. The patient needs to wear a mask during placement of an epidural catheter for labor and delivery.
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B. A sterile gown should be worn during insertion of epidural or nerve block catheters.
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C. A fresh unsterile glove should be used to cover an ultrasound probe used for real-time needle guidance.
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D. There is no valid surveillance method for regional analgesia catheter-related infections.
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E. Use of 1% povidone-iodine is recommended for skin disinfection before spinal anesthesia.
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