[Successful infection control in regional anesthesia procedures: observational survey after introduction of the DGAI hygiene recommendations]. / Erfolgreiche Infektionskontrolle bei Regionalanästhesieverfahren: Verlaufsbeobachtung nach Einführung der DGAI-Hygieneempfehlungen.

ABSTRACT

BACKGROUND: In the context of regional anesthesia procedures adverse events rarely occur but are predominantly systemic intoxication due to local anesthetics (0.01-0.035 %), nerve injuries (0.01-1.7 %) and infections (0-3.2 %). MATERIALS AND METHODS: In a level 1 trauma centre data from all continuous peripheral nerve blocks (cPNB) were prospectively acquired over a period of 8 years (2002-2009) in an observational study (n = 10,549). The acquisition of data was carried out in an intranet-based data bank which was accessible for 24 h on every anesthesia workstation. The collected data included type of block, catheter duration and accompanying complications. This study was carried out with special respect to infectious complications (inflammation and infection). RESULTS: In the years 2002-2004 unexpectedly high rates of infectious complications were observed in 3,491 cPNBs with 146 inflammations (4.2 %) and 112 infections (3.2 %). Based on these alarming findings the existing hygiene regime was revised. The innovations were incorporated into the "Hygiene recommendations for the initiation and continued care of regional anaesthetic procedures" of the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI). A major change was the extension of skin disinfection to a spray-and-scrub combined procedure lasting 10 min. The introduction of this care bundle was carried out in 2005. Among 7,053 cPNBs that were conducted between 2005 and 2009 inflammation occurred in only 183 procedures (2.6 %) and infection in 61 procedures (0.9 %). This reduction was highly significant in both categories (p < 0.001). The risk factors catheter duration and catheter localization statistically remained unchanged during the observational period CONCLUSION: Using a real-time computer-based tool for data capture makes a veritable detection of adverse events possible. Such a tool also has the power to monitor the effects of changes in clinical procedures (SOP). In this case it was possible to verify the successful introduction of an extended hygiene care bundle. The new regime significantly decreased the rate of infections in cPNB.