Best practice & research. Clinical anaesthesiology
-
Most patients in the hospital need vascular access: a peripheral venous line, a short-term non-cuffed central venous catheter (CVC), a long-term cuffed CVC, an implantable port or an arterial line. Such devices, although often indispensable and of benefit, may have the disadvantage of mechanical complications, local exit-site infections or catheter-associated bloodstream infections (CRBSI). ⋯ The risk for CRBSI of such catheters is high with an incidence density of 2 to 7 episodes per 1000 catheter-days depending on ward-type, institution and geographical region. This review describes the epidemiology, the frequency and the risk of CRBSI among non-cuffed CVCs, provides accepted definitions as well as descriptions of diagnostic techniques and highlights various prevention measures.
-
Best Pract Res Clin Anaesthesiol · Sep 2008
ReviewThe "six sigma approach" to the operating room environment and infection.
The patient's external environment plays a significant, and in some cases dominant, role in his or her infection risk. The use of ultraclean air for certain procedures, as well as avoidance of hypothermia have been proven to reduce the risk of infection. ⋯ More research needs to be done in order to determine whether OR design changes, in addition to increasing OR efficiency and thus reducing case times, can also reduce infection rates. Further research is also needed to determine whether or not double gloves and/or the use of antiseptic scrubbing in addition to painting are efficacious.
-
Surgical wound infection remains a common and serious complication of surgery. Patient factors are a major determinant of wound outcome following surgery. Co-morbidities clearly contribute, but environmental stressors as well the individual response to stress may be equally important. ⋯ Once perfusion is assured, addition of increased inspired oxygen substantially reduces surgical site infection in at risk patients. A greater degree of hyperoxemia, achievable with administration of hyperbaric oxygen, is useful as an adjunct to the treatment of serious soft tissue and bone infections in selected patients. This article will review the basic science underlying these observations, along with the clinical data that support the use of hyperoxia in preventing and treating infections.
-
Postoperative infection is not only a major source of morbidity and mortality in patients undergoing surgery, but also an important cause of increased hospital stay and resource utilization. Diabetes has been shown in multiple studies to increase the risk of post-surgical infection. ⋯ This paper will review the effects of intra-operative, postoperative, and long-term glycemic control on postoperative infection rates. The mechanisms by which surgery causes hyperglycemia will be reviewed, as well as the immunologic and humeral effects of hyperglycemia.
-
Best Pract Res Clin Anaesthesiol · Sep 2008
ReviewThe immunocompromised pediatric patient and surgery.
Surgical procedures routinely challenge the pediatric host defense mechanisms. In normal situations the innate and adaptive immune mechanisms are prepared for this challenge. ⋯ The etiology of the immunocompromised state in pediatric patients may be primary (SCID, hypogammaglobulinemia) or secondary (cystic fibrosis, sickle cell disease). Knowledge of the basic elements of the immune system and how these elements are altered in the immunocompromised patient will help guide peri-operative management.