Anaesthetists and syringe hygiene: getting to the pointy end – a summary of recommendations

Susceptibility of two different PCA pumps to inaccurate delivery associated with pole position at low flow-rates in a pediatric setting - an experimental study

PURPOSE

Vertical displacement of infusion pumps used in patient-controlled analgesia can cause irregularities in drug delivery and is especially crucial at low flow rates, which are commonly used in pediatrics. There is only scarce data available regarding the extent of these inaccuracies. The current in vitro study therefore aimed at a comparison of the performance of two commonly used PCA pumps at different pole positions due to vertical displacement.

METHODS

The Syramed® µSP6000 Chroma syringe infusion pump featuring a stepper motor drive was compared to the CADD®-Solis pump utilizing a linear peristaltic pump system at two different flow rates (0.3 ml/h and 1 ml/h) and three different levels of height (0, + 50 and - 50 cm). Flow patterns and delivered volumes were measured after every change in position and infusion boluses, retrograde aspiration volumes and zero-drug delivery time were calculated.

RESULTS

The Syramed® pump was more susceptible to vertical displacement than the CADD®-Solis pump and showed overall greater inaccuracies in the delivered volumes as well as higher infusion boluses, retrograde aspiration volumes and zero-drug delivery time at both flow rates.

CONCLUSION

The observed differences between the pumps might be explained by the higher compliance of this syringe pump and the diverse working mechanisms. Overall, the CADD®-Solis pump might be considered a preferable option for patient-controlled analgesia in children. It is nonetheless essential for medical staff to be aware of the effects of vertical displacement of PCA pumps and to minimize these displacements as much as possible.

Cutaneous Abscess Prevalence and Risk Factors Among People Who Inject Drugs in Denver, Colorado

Background

Skin and soft tissue infections (SSTIs) are considered common problems for people who inject drugs (PWID), yet few studies actually quantify injection-related SSTIs or identify contributing risk behaviors. We report the prevalence of self-reported cutaneous abscesses among PWID and explore associations between abscesses and injection-related behaviors.

Methods

PWID were recruited to participate in the National HIV Behavioral Surveillance system in Denver, Colorado, and answered questions about their experiences with abscesses and injection-related activities. We used χ2 statistics to assess differences between sociodemographic and healthcare characteristics and injection-related behaviors associated with self-reported abscess in the past 12 months. We used generalized linear models to estimate the unadjusted and adjusted prevalence ratios to describe the association between using sterile needles and abscess in the past 12 months. We also examined the association between using alcohol swabs and abscess in the past 12 months.

Results

Of the 533 participants who completed the survey in 2018, 257 (48%) reported having at least 1 abscess in the past 12 months while 98 of the 277 (35%) participants in 2022 reported an abscess. In both 2018 and 2022, participants who reported less consistent use of sterile needles were significantly more likely to report having an abscess in the past 12 months.

Conclusions

These findings highlight the relatively high prevalence of recent abscesses among PWID and underscore the need to identify simple, accessible prevention strategies for use in clinical and nonclinical settings.

The relative efficacy of multiple syringe tip disinfection techniques against virulent staphylococcus contamination

BACKGROUND

A recent study confirmed significant contamination of syringe tips following routine anaesthesia practice of at least 6 h in duration.

AIM

We assessed the relative efficacy of clinically relevant syringe tip disinfection techniques following contamination with the hyper transmissible and more pathogenic Staphylococcus aureus sequence type 5 (S. aureus ST5) strain characteristic associated with increased strength of biofilm formation and greater desiccation tolerance.

METHODS

Syringe tips (N=40) contaminated with S. aureus ST5 were randomized to 70% isopropyl pads with 10 or 60 s of drying time, scrubbing alcohol disinfection caps with 10 or 60 s of dwell time, or to non-scrubbing alcohol disinfection caps with 60 s of dwell time. The primary outcome was residual 24-h colony forming units (cfu) >10.

RESULTS

Scrubbing disinfection caps were more effective than alcohol pads (25% (12/48) <10 cfu for scrubbing caps (10- or 60-s dwell times) vs 0% (0/48) <10 cfu for alcohol pads (10 or 60 s of drying time), Holm-Sidak adjusted P=0.0016). Scrubbing disinfection caps were more effective than non-scrubbing alcohol disinfection caps (25% (12/48) <10 cfu for scrubbing alcohol caps (10- or 60-s dwell times) vs 2% (1/48) for non-scrubbing alcohol caps (60-s dwell time), adjusted P=0.0087).

CONCLUSIONS

Scrubbing alcohol caps are more effective than alcohol pads or non-scrubbing disinfecting caps for microbial reduction of syringe tips contaminated with the more pathogenic S. aureus ST5.

A Comprehensive Review on the Efficacy of Nerve Blocks in Reducing Postoperative Anesthetic and Analgesic Requirements

The purpose of this article review is to investigate whether or not nerve blocks are beneficial in minimizing the amount of postoperative anesthetic and analgesic medication required, hence improving patient outcomes and reducing healthcare costs. This review investigates several different kinds of nerve blocks, their administration techniques, and the anatomical and physiological aspects that influence nerve block effectiveness. It analyzes the impact of nerve blocks on opioid use, postoperative pain scores, and the incidence of opioid-related adverse effects by compiling the findings of numerous large-scale, randomized, controlled trials. Infection, hematoma, nerve injury, and systemic toxicity are some potential complications of nerve blocks discussed in the article. It concludes with recommendations for optimizing nerve block techniques in clinical practice and identifies areas that require further research, such as the development of new anesthetics and the identification of patient subgroups that would benefit the most from nerve blocks. In addition, it provides recommendations for optimizing nerve block techniques in clinical practice.

Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures: a post-implementation prospective case-cohort study

STUDY OBJECTIVE

A randomized controlled study demonstrated that an optimized intraoperative infection control program targeting basic preventive measures can reduce Staphylococcus aureus transmission and surgical site infections. In this study we address potential limitations of operating room heterogeneity of infections and compliance with behavioral interventions following adoption into clinical practice.

DESIGN

A post-implementation prospective case-cohort study.

SETTING

Twenty-three operating rooms at a large teaching hospital.

PATIENTS

A total of 801 surgical patients [425 (53%) women; 350 (44%) ASA > 2, age 54.6 ± 15.9 years] were analyzed for the primary and 804 for the secondary outcomes.

INTERVENTIONS

A multifaceted, evidence-based intraoperative infection control program involving hand hygiene, vascular care, and environmental cleaning improvements was implemented for 23 operating room environments. Bacterial transmission monitoring was used to provide monthly feedback for intervention optimization.

MEASUREMENTS

S. aureus transmission (primary) and surgical site infection (secondary).

MATERIALS AND METHODS

The incidence of S. aureus transmission and surgical site infection before (3.5 months) and after (4.5 months) infection control optimization was assessed. Optimization was defined by a sustained reduction in anesthesia work area bacterial reservoir isolate counts. Poisson regression with robust error variances was used to estimate the incidence risk ratio (IRR) of intraoperative S. aureus transmission and surgical site infection for the independent variable of optimization.

MAIN RESULTS

Optimization was associated with decreased S. aureus transmission [24% before (85/357) to 9% after (42/444), IRR 0.39, 95% CI 0.28 to 0.56, P < .001] and surgical site infections [8% before (29/360) and 3% after (15/444) (IRR 0.42, 95% CI 0.23 to 0.77, P = .005; adjusted for American Society of Anesthesiologists' physical status, aIRR 0.45, 95% CI 0.25 to 0.82, P = .009].

CONCLUSION

An optimized intraoperative infection control program targeting improvements in basic preventive measures is an effective and feasible approach for reducing S. aureus transmission and surgical site infection development.

Challenges in reducing the risk of infection when accessing vascular catheters

Injection safety is essential to reduce the risk of healthcare-associated infections (HAIs) when accessing vascular catheters. This general review evaluates the contamination of vascular catheter access ports and associated HAIs in acute care settings, focusing on open lumen stopcocks (OLSs) and disinfectable needleless closed connectors (DNCCs). PubMed was searched from January 2000 to February 2021. OLS intraluminal surfaces are frequently contaminated during patient care, increasing the risk of HAIs, and neither an isopropyl alcohol (IPA) pad nor a port-scrub device can reduce contamination effectively. In contrast, DNCCs can be disinfected, with most studies indicating less intraluminal contamination than OLSs and some studies showing decreased HAIs. While the optimal DNCC design to reduce HAIs needs to be determined, DNCCs alone or stopcocks with a DNCC bonded to the injection port should replace routine use of OLSs, with OLSs restricted to use in sterile fields. Compliance with disinfection is essential immediately before use of a DNCC as use of a non-disinfected DNCC can have equivalent or greater risk of HAIs compared with use of an OLS. The recommendations for access port disinfection in selected national and international guidelines vary. When comparing in-vitro studies, clinical studies and published guidelines, consensus is lacking; therefore, additional studies are needed, including large randomized controlled trials. IPA caps disinfect DNCCs passively, eliminate scrubbing and provide a contamination barrier; however, their use in neonates has been questioned. Further study is needed to determine whether IPA caps are more efficacious than scrubbing with disinfectant to decrease HAIs related to use of central venous, peripheral venous and arterial catheters.