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Chapter 186: Infection Control

Pamela Bland

INTRODUCTION

Approximately 2 million people are infected with healthcare-associated infections (HAIs) in the United States annually. This results in 90 000 deaths and over $5 billion in expenses per year. The most prevalent HAIs, responsible for over 80% of infections, are listed in Table 186-1.

TABLE 186-1Healthcare-Associated Infections (HAIs)
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TABLE 186-1 Healthcare-Associated Infections (HAIs)

  1. Urinary tract infections, 35% (most commonly catheter related)

  2. Surgical site infections (SSIs), 20%

  3. Bloodstream infections, 15% (most commonly related to an intravenous [IV] catheter)

  4. Pneumonia, 15% (most commonly ventilator associated)

The Department of Health and Human Services (HHS) Action Plan to Prevent HAIs was formulated in 2008. The Centers for Medicare and Medicaid Services (CMS) reinforced the impact of the HHS plan by utilizing pay for reporting and performance in regard to methods to decrease HAIs. Anesthesiologists reduce the incidence of HAI with implementation of best practices for prevention of surgical site infections (SSIs), central line infections, ventilator-associated pneumonia, and methicillin-resistant Staphylococcus aureus (MRSA).

PREVENTION OF HEALTHCARE-ASSOCIATED INFECTION

Hand Hygiene

Hand washing is a simple and effective way to decrease patient HAI and to protect the provider (Table 186-2). Alcohol-based solutions are recommended for hand hygiene when there is no visible contamination. However, in the case of visible contamination, hand washing with soap and water should be performed. Spore-forming Clostridium difficile and Bacillus anthracis are poorly inactivated by alcohol-based solutions. They require hand washing with soap and water.

TABLE 186-2Indications for Hand Hygiene
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TABLE 186-2 Indications for Hand Hygiene

  1. Before and after direct contact with patients

  2. Before donning sterile gloves

  3. After contact with body fluids, nonintact skin, mucous membranes, wound dressings

  4. When hands that have contacted a contaminated body area will subsequently contact a clean site

  5. After contact with high-touch environmental surfaces in the vicinity of the patient

  6. After removal of gloves (of note, hands are considered contaminated after glove removal due to the incidence of glove failure and self-contamination on glove removal)

  7. Before eating

  8. After using the restroom

Human hands carry 3.9 × 104 to 4.6 × 106 colony-forming units/cm2 of bacteria. Subungual locations, or beneath the fingernails, have the highest bacterial concentrations and are frequently colonized with coagulase-negative Staphylococcus, gram-negative rods, Corynebacteria, and yeast.

Prevention of Surgical Site Infections

Anesthesiologists contribute to several aspects of SSI prevention (Table 186-3).

TABLE 186-3Perioperative Factors to Reduce SSI
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TABLE 186-3 Perioperative Factors to Reduce SSI

  1. Temperature—Hypothermia (<36°C) decreases perfusion and thus oxygen supply to the wound. It reduces production of superoxide radials. Bactericidal activity by neutrophils is reduced in the presence of ...

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