Skip to main content
SpringerLink
Log in

Erfolgreiche Infektionskontrolle bei Regionalanästhesieverfahren

Verlaufsbeobachtung nach Einführung der DGAI-Hygieneempfehlungen

Successful infection control in regional anesthesia procedures

Observational survey after introduction of the DGAI hygiene recommendations

  • Originalien
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Infektionen zählen zu den seltenen, aber ernsthaften Komplikationen, die regionalanästhesiologische Verfahren begleiten können.

Material und Methoden

In einer Unfallklinik der Maximalversorgung wurden über einen Zeitraum von 8 Jahren alle kontinuierlichen peripheren Nervenblockaden („continuous peripheral nerve block“, cPNB) im Rahmen einer prospektiven Beobachtungsstudie computergestützt erfasst (n = 10.549) und bezüglich infektiologischer Komplikationen ausgewertet.

Ergebnisse

Von 2002–2004 wurden bei 3491 cPNB unerwartet hohe Infektionsraten beobachtet (Inflammation: 4,2%, Infektion: 3,2%). Daraus resultierend wurde das bestehende Hygieneregime überarbeitet. Die Neuerungen flossen in die „Hygieneempfehlungen für die Anlage und weiterführende Versorgung von Regionalanästhesie-Verfahren“ der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) ein. Nach Einführung dieses Maßnahmenbündels wurde von 2005–2009 bei 7053 cPNB die Infektionsrate deutlich gesenkt (Inflammation 2,8%, p < 0,001; Infektion 0,9%, p < 0,001). Die Risikofaktoren Liegedauer und Katheterlokalisation blieben über den Beobachtungszeitraum unverändert.

Schlussfolgerung

Durch die Einführung des neuen, erweiterten Hygieneregimes konnte die Infektionsrate bei cPNB statistisch hochsignifikant gesenkt werden.

Abstract

Backround

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Auroy Y et al (2002) Major complications of regional anesthesia in France. Anesthesiology 97:1274–1280

    Article  PubMed  Google Scholar 

  2. Aly H et al (2005) Is bloodstream infection preventable among premature infants? Pediatrics 115:1513

    Article  PubMed  Google Scholar 

  3. Borgeat A et al (2003) Evaluation of the lateral modified approach for continuous interscalene block after shoulder surgery. Anesthesiology 99:436–442

    Article  PubMed  Google Scholar 

  4. Büttner J et al (1999) Komplikationen. In: Büttner J, Meier G (Hrsg) Kontinuierliche periphere Techniken zur Regionalanästhesie und Schmerztherapie. UNI-MED, Bremen, S 51–52

  5. Capdevila X et al (2005) Continuous peripheral nerve blocks in hospital wards after orthopedic surgery. Anesthesiology 103:1035–1045

    Article  PubMed  Google Scholar 

  6. Capdevila X et al (2008) Acute neck cellulitis and mediastinitis complicating a continuous interscalene block. Anesth Analg 107:1419–1421

    Article  PubMed  Google Scholar 

  7. Capdevila X et al (2009) Infectious risk of continuous peripheral nerve blocks. Anesthesiology 110:182–188

    Article  PubMed  Google Scholar 

  8. Cook T (2009) Major complications of central neuraxial block. Br J Anaesth 102:179–190

    Article  PubMed  CAS  Google Scholar 

  9. Cuvillon P et al (2001) The continuous femoral nerve block catheter for postoperative analgesia. Anesth Analg 93:1045–1049

    Article  PubMed  CAS  Google Scholar 

  10. Engelhardt L et al (2008) A network for the safety of regional anaesthesia in Germany. Anaesth Intensivmed 49:55–61

    Google Scholar 

  11. Fagenholz PJ et al (2012) Systemic local anaesthetic toxicity from continuous thoracic paravertebral block. Br J Anaesth 109:260–262

    Article  PubMed  CAS  Google Scholar 

  12. Grewal S et al (2006) Epidural abscesses. Br J Anaesth 97:115–116

    Article  Google Scholar 

  13. Horlocker TT (1998) Peripheral nerve blocks—regional anesthesia for the new millennium. Reg Anesth Pain Med 23:237–240

    Article  PubMed  CAS  Google Scholar 

  14. Klein SM et al (1999) Anxiety, vocalization and agitation following peripheral nerve block with ropivacaine. Reg Anesth Pain Med 24:175–178

    PubMed  CAS  Google Scholar 

  15. Moen V et al (2004) Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology 101:950–959

    Article  PubMed  CAS  Google Scholar 

  16. Morin AM et al (2005) Risk factors for bacterial catheter colonization in regional anaesthesia. BMC Anesthesiol 5:1–9

    Article  PubMed  Google Scholar 

  17. Morin AM et al (2006) Hygiene recommendations for the initiation and continued care of regional anaesthetic procedures. Anaesth Intensivmed 47:372–379

    Google Scholar 

  18. Neuburger M et al (2006) Complication and adverse events in cPNB: results of investigations on 3,491 catheters. Anaesthesist 55:33–40

    Article  PubMed  CAS  Google Scholar 

  19. Neuburger M et al (2007) Inflammation and infection complications of 2285 perineural catheters. Acta Anaesthesiol Scand 51:108–114

    Article  PubMed  CAS  Google Scholar 

  20. Neuburger M et al (2009) Infection control in continuous peripheral regional anesthesia. Anaesthesist 58:795–799

    Article  PubMed  CAS  Google Scholar 

  21. Nseir S et al (2004) Fatal streptococcal necrotizing fasciitis as a complication of axillary brachial plexus block. Br J Anaesth 92:427–429

    Article  PubMed  CAS  Google Scholar 

  22. Robert- Koch-Institut (2003) Aktuelle Daten des Krankenhaus-Infektions–Surveillance-System KISS. Epidemiologisches Bulletin Nr. 36

  23. Robert-Koch-Institut (2002) Prävention Gefäßkatheterassoziierterinfektionen. Bundesgesundheitsblatt 45:907–222

    Article  Google Scholar 

  24. Ruetsch YA et al (1999) Ropivacaine-induced convulsions and severe cardiac dysrhythmia after sciatic block. Anesthesiology 90:1784–1786

    Article  PubMed  CAS  Google Scholar 

  25. Schulz-Stübner S et al (2007) Regional anesthesia surveillance system. Acta Anaesthesiol Scand. 51:305–315

    Google Scholar 

  26. Sindhaghatta et al (2010) Study of device use adjusted rates in health care–associated infections after implementation of „bundles“ in a closed-model medical intensive care unit. J Crit Care 25:174.e11–174.e18

    Google Scholar 

  27. Volk T et al (2009) Incidence of infection from catheter procedures for regional anesthesia. Anaesthesist 58:1107–1112

    Article  PubMed  CAS  Google Scholar 

  28. Vonberg RP et al (2005) Infection control measures in intensive care units. Anaesthesist 54:975–978, 980–982

    Article  PubMed  Google Scholar 

  29. Wagner K et al (2011) Häufige Verbandswechsel als Risikofaktor für die bakterielle Kolonisation bei regionalanästhesiologischen Katheterverfahren. Deutscher Anästhesiekongress, PO 3.3.8

  30. Reisig F et al (2007) 5-year course of infections in 6089 cPNB in a level one trauma center. Reg Anesth Pain Med 32:S18

    Google Scholar 

  31. Reisig F et al (2012) Ultraschall – Luxus oder Allgemeingut. HS 101.2. Deutscher Anästhesiecongress, Leipzig

  32. Grau T et al (2004) Survey on current practice of regional anaesthesia in Germany, Austria, and Switzerland. Anaesthesist 53:847–855

    Article  PubMed  CAS  Google Scholar 

  33. Ilfeld BM (2011) Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg 113:904–925

    Article  PubMed  Google Scholar 

  34. Aguirre J et al (2012) The role of continuous peripheral nerve blocks. Anesthesiol Res Pract 560879 (Epub 2012 June 18)

  35. Hebl JR et al (2011) Infectious complications of regional anesthesia. Curr Opin Anaesthesiol 24:573–580

    Article  PubMed  Google Scholar 

  36. Neuburger M et al (2011) Complications of peripheral regional anesthesia. Anaesthesist 60:1014–1026

    Article  PubMed  CAS  Google Scholar 

  37. Reisig F et al (2009) Identification of six predictive factors for infectious complication in cPNB. Reg Anesth Pain Med 34:S62

    Google Scholar 

Download references

Danksagung

Die Autoren bedanken sich bei allen pflegerischen und ärztlichen Kollegen, ohne deren steten Einsatz in der Dokumentation und insbesondere in der gewissenhaften Durchführung und Nachsorge der Regionalanästhesieverfahren dieser Erfolg zum Wohl der Patienten nicht möglich gewesen wäre.

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Abteilung für Anästhesie, Zentrum für interdisziplinäre Intensivmedizin und Druckkammerzentrum, BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland

    F. Reisig & J. Büttner

  2. Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland

    Y.A. Zausig & B.M. Graf

  3. Abteilung für Anästhesie und Intensivmedizin, Ortenau Klinikum Achern und Oberkirch, Achern, Deutschland

    M. Neuburger

Authors
  1. F. Reisig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Neuburger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y.A. Zausig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B.M. Graf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Büttner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Reisig.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reisig, F., Neuburger, M., Zausig, Y. et al. Erfolgreiche Infektionskontrolle bei Regionalanästhesieverfahren. Anaesthesist 62, 105–112 (2013). https://doi.org/10.1007/s00101-012-2122-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-012-2122-1

Schlüsselwörter

Keywords

Search

Navigation