Safety guideline: skin antisepsis for central neuraxial blockade

Campbell, Jennifer; Plaat, F.; Checketts, M. R.; Bogod, David; Tighe, S. Q. M.; Moriarty, A.; Koerner, Roland

doi:10.1111/anae.12844

Cited by 77 publications

(10 citation statements)

References 52 publications

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“…Afterwards, a head wash was performed every 12 h with povidone-iodine soap the first 72 h and surgical wound-care was carried out every 24 h under strict aseptic conditions. Povidine-iodine was used instead of 2% clorhexidine because of neurotoxicity [13].…”

Section: Methodsmentioning

confidence: 99%

Risk factors for surgical site infection after craniotomy: a prospective cohort study

Jiménez-Martínez

Cuervo

Hornero

et al. 2019

Antimicrob Resist Infect Control

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Background Although surgical site infection after craniotomy (SSI-CRAN) is a serious complication, risk factors for its development have not been well defined. We aim to identify the risk factors for developing SSI-CRAN in a large prospective cohort of adult patients undergoing craniotomy. Methods A series of consecutive patients who underwent craniotomy at a university hospital from January 2013 to December 2015 were prospectively assessed. Demographic, epidemiological, surgical, clinical and microbiological data were collected. Patients were followed up in an active post-discharge surveillance programm e for up to one year after surgery. Multivariate analysis was carried out to identify independent risk factors for SSI-CRAN. Results Among the 595 patients who underwent craniotomy, 91 (15.3%) episodes of SSI-CRAN were recorded, 67 (73.6%) of which were organ/space. Baseline demographic characteristics were similar among patients who developed SSI-CRAN and those who did not. The most frequent causative Gram-positive organisms were Cutibacterium acnes (23.1%) and Staphylococcus epidermidis (23.1%), whereas Enterobacter cloacae (12.1%) was the most commonly isolated Gram-negative agent. In the univariate analysis the factors associated with SSI-CRAN were ASA score > 2 (48.4% vs. 35.5% in SSI-CRAN and no SSI-CRAN respectively, p = 0.025), extrinsic tumour (28.6% vs. 19.2%, p = 0.05), and re-intervention (4.4% vs. 1.4%, p = < 0.001). In the multivariate analysis, ASA score > 2 (AOR: 2.26, 95% CI: 1.32–3.87; p = .003) and re-intervention (OR: 8.93, 95% CI: 5.33–14.96; p < 0.001) were the only factors independently associated with SSI-CRAN. Conclusion The risk factors and causative agents of SSI-CRAN identified in this study should be considered in the design of preventive strategies aimed to reduce the incidence of this serious complication. Electronic supplementary material The online version of this article (10.1186/s13756-019-0525-3) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Risk factors for surgical site infection after craniotomy: a prospective cohort study

Jiménez-Martínez

Cuervo

Hornero

et al. 2019

Antimicrob Resist Infect Control

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“…There is no clear consensus definition of PNC infection in the literature, and definitive criteria for distinguishing between infection and inflammation are lacking. PNC infection may be defined as the presence of local signs of inflammation, a purulent catheter site exudate and systemic signs of infection, or simply as the presence of two of the following three symptoms: redness, swelling, and pain [26]. It is not possible to conclude from our results that the use of chlorhexidine would decrease the rate of PNC infection.…”

Section: Discussionmentioning

confidence: 77%

“…Despite the very heterogeneous nature of the studies performed to date, academic societies in Britain and Ireland have already proposed recommendations for the use of alcoholic chlorhexidine in cutaneous antisepsis for central venous or neuraxial catheters [26]. We believe that our results have important implications for daily clinical practice and that anaesthetists should be aware of the superiority of chlorhexidine in this context.…”

Section: Discussionmentioning

confidence: 79%

“…It is not possible to conclude from our results that the use of chlorhexidine would decrease the rate of PNC infection. Thirdly, in the absence of data on antimicrobial efficacy for chlorhexidine concentrations of 2% and 0.5%, recent guidelines have favoured using 0.5% of chlorhexidine [26]. There is evidence to suggest that 2% chlorhexidine use may be associated with ototoxicity [27], irreversible damage to the cornea following minimal splash exposure [28] and severe cutaneous allergic reactions in 3% of cases [19].…”

Section: Discussionmentioning

confidence: 99%

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Two per cent alcoholic chlorhexidine versus alcoholic five per cent povidone-iodine for the prevention of perineural catheter colonisation: The CHLOVEPI randomised, controlled trial

Harkouk

Thibault-Sogorb

Beauchet

et al. 2021

Anaesthesia Critical Care & Pain Medicine

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“…Limited case report-based information is available on chlorhexidine risk of neurotoxicity. In some of them, a much larger quantity of chlorhexidine than is routinely used for skin disinfection was mistakenly injected into the spinal canal and led to chronic adhesive arachnoiditis with progressive neurological deterioration 24. Recent guidelines from Great Britain and Ireland recommend the use of chlorhexidine in alcohol for skin antisepsis before performing central neuroaxial blockade, while taking meticulous measures to prevent chlorhexidine from reaching the CSF 24…”

Section: Discussionmentioning

confidence: 99%

<p>Adhesive arachnoiditis following lumbar epidural steroid injections: a report of two cases and review of the literature</p>

Eisenberg¹,

Goldman²,

Schlag-Eisenberg³

et al. 2019

JPR

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Lumbar epidural steroid injections (LESIs) are commonly used for managing lower back pain (LBP) and radicular pain. LESIs are generally considered safe with only rare serious complication. One very rare complication that is frequently cited in the literature is adhesive arachnoiditis. However, a literature search failed to detect even one published manuscript, clearly documenting LESI induced arachnoiditis. This article presents two patients who received a transforaminal L5–S1 and two L3–L4 interlaminar LESIs. Although the presented patients developed clear radiological (MRI) findings of arachnoiditis, they were not accompanied by any improvement or deterioration in their clinical condition. The article also reviews the literature on the prevalence, pathogenesis, diagnosis, and clinical features of adhesive arachnoiditis. Literature suggests that adhesive arachnoiditis following LESIs is a rare entity, which – as seen in our patients – has clear radiological characteristics but uncertain pathogenesis. It has a large spectrum of clinical presentation, ranging from an incidental finding to a serious neurological sequela. In at least some patients with adhesive arachnoiditis following LESI, the radiological and clinical findings may fail to correlate with each other. In light of the fact that LESI is one of the most commonly performed procedures for managing LBP, clinicians should be aware of this rare yet existing entity.

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Safety guideline: skin antisepsis for central neuraxial blockade

Cited by 77 publications

References 52 publications

Risk factors for surgical site infection after craniotomy: a prospective cohort study

Risk factors for surgical site infection after craniotomy: a prospective cohort study

Two per cent alcoholic chlorhexidine versus alcoholic five per cent povidone-iodine for the prevention of perineural catheter colonisation: The CHLOVEPI randomised, controlled trial

<p>Adhesive arachnoiditis following lumbar epidural steroid injections: a report of two cases and review of the literature</p>

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