Infection Control during Anaesthetic Procedures
The risk of infection is dependent on the procedure and the level of barrier protection. Guidelines for monitoring have been published by the Association of Anaesthetists and should be followed at all times.
Infection control while using ultrasound.
Ultrasound is used for many anaesthetic procedures. The probe should have a sterile protective
cover for each patient use. This may be an adhesive transparent dressing. If there is any risk of
contamination of the probe by blood or other bodily fluids, then the probe should be sent off for
sterilisation.
Infection control during venous and arterial catheterization.
For both peripheral venous access and arterial cannulation the use of a sterile pack and a ‘no touch’
technique is recommended. Thorough hand washing, non-sterile gloves and skin disinfection
should be employed for peripheral venous access. For arterial access, sterile gloves should be used
to palpate the artery and when directly handling the needle, guidewire and catheter.
Infection control during central venous catheterization.
For central venous access, including peripherally inserted central catheters, maximal barrier
precautions should be used. The skin entry site should be cleaned with 2% chlorhexidine
gluconate in 70% alcoholand allowed to dry before proceeding. For patients sensitive to
chlorhexidine, povidone iodine may be used. The preference is for upper extremity catheters.
Once sited, the catheter should be anchored, an antiseptic disc sited and a sterile dressing
applied. The device should be accessed in a sterile manner, reviewed daily and removed at the
earliest opportunity.
Infection control for peripheral nerve blockade.
Although infectious complications associated with peripheral nerve blocks are rare, they can be
disastrous. The nerves targeted by some peripheral nerve blocks lie close to the neuraxis and 0.5%
chlorhexidine gluconate in 70% alcohol should be used when performing peripheral nerve blocks.
Infection control for central neuraxial blockade.
For central neuraxial blockade, an aseptic technique should be used. The skin entry site should be
cleaned with 0.5% chlorhexidine gluconate in 70% alcohol. There is evidence that chlorhexidine
causes neurotoxicity and, given the lack of evidence of the antimicrobial superiority of a 2%
solution over 0.5% solution, the use of a 0.5% solution is preferred. The anaesthetist should
be meticulous in taking measures to prevent chlorhexidine from reaching the cerebrospinal fluid.
Chlorhexidine should be kept well away from the drugs and equipment used for the procedure,
the solution should be allowed to dry before the skin is palpated or punctured and the anaesthetist
should check their gloves for contamination with chlorhexidine and change them if there is any
doubt.
For example, tunnelled epidural catheters may reduce the
incidence of infection and prophylactic antibiotics may be indicated in special circumstances.
In November 2009, the National Patient Safety Agency recommended that equipment should
be developed that will enable NHS institutions to perform all epidural, intrathecal and regional
infusions and boluses with devices that will not connect with intravenous Luer connectors or
intravenous infusion spikes.
Infection control for bladder catheterization
Anaesthetists who place urinary catheters should ensure safe insertion and maintenance of the
catheter and its removal as soon as it is no longer required. This includes assessing the need for the
catheter, undertaking appropriate hand hygiene and following correct protocols for insertion and
maintenance and antibiotic prophylaxis when indicated.