Best Practice in Aseptic Technique
Transcript of Best Practice in Aseptic Technique
![Page 1: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/1.jpg)
Best Practice in Aseptic TechniqueDavid Bogod, Nottingham
![Page 2: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/2.jpg)
![Page 3: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/3.jpg)
324,950 spinals
Abscess - 2 Arachnoiditis - 1Meningitis - 2
![Page 4: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/4.jpg)
J Pathology Bacteriology 1955; 70: 167-178
![Page 5: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/5.jpg)
CetrimideTwo other cationic detergentsOne anionic detergentOne non-ionic detergent1:6-Di-4’-chlorophenyldiguanidohexane diacetate
![Page 6: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/6.jpg)
1:6-Di-4’-chlorophenyldiguanidohexane diacetate
![Page 7: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/7.jpg)
Chlorhexidine
✤ 0.02% Microscopic changes
✤ 0.05% Death at 7 days, dilated ventricles
✤ 0.1% Death at 24 hours after fitting
![Page 8: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/8.jpg)
Chlorhexidine
✤ Direct degeneration of nervous tissue
✤ Cellular proliferation and inflammation of meninges → blockage
✤ Necrosis of vascular media and adventitia → luminal obliteration
![Page 9: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/9.jpg)
![Page 10: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/10.jpg)
“There are known knowns. These are things we know that we know. There are
known unknowns. That is to say, there are things that we now know we don’t know. But there are also unknown unknowns.
These are things we do not know we don’t know.” We don’t know what happened to Angelique, but at least now we know we
don’t know.
Anaesthesia News 2010; 271: 7-8
![Page 11: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/11.jpg)
The Importance and Implications of Aseptic Techniques During Regional Anesthesia
Hebl, JR
Reg Anesth Pain Med 2006; 31: 311-323
![Page 12: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/12.jpg)
✤ Neither Chlorhexidine nor Povidone approved by FDA - lack of clinical data
✤ Povidone less effective than Chlorhexidine:
✤ Requires longer contact
✤ Limited duration of action
✤ Neutralised by organic material
✤ Acute skin reactions
✤ Bacterial resistance esp. Staph Aureus
![Page 13: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/13.jpg)
“...alcohol-based chlorhexidine solutions should be considered the antiseptic of choice before regional anesthetic techniques (Grade A)”
Reg Anesth Pain Med 2006; 31: 311-323
![Page 14: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/14.jpg)
![Page 15: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/15.jpg)
![Page 16: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/16.jpg)
![Page 17: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/17.jpg)
![Page 18: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/18.jpg)
“If we use povidone-iodine for skin preparation and the patient develops a bacterial meningitis after a spinal puncture, we could be criticized for not using CHG as recommended by the guidelines. Alternatively, if we use CHG and the patient develops a neural deficit for whatever reason, we could be criticized for using CHG. It then becomes a battle of the experts”.
Chlorhexidine or Povidone-IodineDo We Follow the Guidelines or the Package Insert?
Dailey PA. CSA Bulletin, Summer 2009
![Page 19: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/19.jpg)
British Journal of Anaesthesia 2009; 103: 456–57
Antiseptic solutions for central neuraxial blockade: which concentration of
chlorhexidine in alcohol should we use?
![Page 20: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/20.jpg)
British Journal of Anaesthesia 2009; 103: 456–57
Can the authors please comment on whether they reached any conclusion after their audit on which concentration of chlorhexidine in alcohol is the safest antiseptic solution to use?
![Page 21: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/21.jpg)
British Journal of Anaesthesia 2009; 103: 456–57
The use of a concentration of CHG > 0.5% cannot be supported; this concentration is evidently effective, but a greater one might increase the risk of neurotoxicity from inadvertent contamination, and should be avoided... It is our opinion (a poor level of evidence!) that, on the limited evidence available to us, chlorhexidine 0.5% in alcohol 70% is the optimal skin preparation for neuraxial procedures
![Page 22: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/22.jpg)
British Journal of Anaesthesia 2009; 103: 456–57
The use of a concentration of CHG > 0.5% cannot be supported; this concentration is evidently effective, but a greater one might increase the risk of neurotoxicity from inadvertent contamination, and should be avoided... It is our opinion (a poor level of evidence!) that, on the limited evidence available to us, chlorhexidine 0.5% in alcohol 70% is the optimal skin preparation for neuraxial procedures
![Page 23: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/23.jpg)
British Journal of Anaesthesia 2009; 103: 456–57
The use of a concentration of CHG > 0.5% cannot be supported; this concentration is evidently effective, but a greater one might increase the risk of neurotoxicity from inadvertent contamination, and should be avoided... It is our opinion (a poor level of evidence!) that, on the limited evidence available to us, chlorhexidine 0.5% in alcohol 70% is the optimal skin preparation for neuraxial procedures
![Page 24: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/24.jpg)
![Page 25: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/25.jpg)
✤ Four further cases:✤ Progressive leg weakness and pain✤ Hydrocephalus✤ Serial shunts✤ Paraplegia
✤ Seven other cases
![Page 26: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/26.jpg)
![Page 27: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/27.jpg)
Regional Anesthesia and Pain Medicine 2012; 37: 131-8
![Page 28: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/28.jpg)
Regional Anesthesia and Pain Medicine 2012; 37: 131-8
![Page 29: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/29.jpg)
Regional Anesthesia and Pain Medicine 2012; 37: 131-8
2% chlorhexidine
22-gauge Quinke needle
1 ml of LA
1:145773 dilution
0.0001372%
![Page 30: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/30.jpg)
Regional Anesthesia and Pain Medicine 2012; 37: 139-44
![Page 31: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/31.jpg)
Regional Anesthesia and Pain Medicine 2012; 37: 139-44
0.04% incidence
12,465 spinals
![Page 32: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/32.jpg)
Antiseptic Precautions
✤ Continue to use chlorhexidine 0.5% in alcohol
✤ Keep equipment covered
✤ Remove antiseptic and sponges from vicinity before uncovering
✤ Check for glove contamination
✤ Allow to dry
![Page 33: Best Practice in Aseptic Technique](https://reader031.fdocuments.us/reader031/viewer/2022022302/62153ec70d4a842c3a6d145c/html5/thumbnails/33.jpg)
What We Don’t Know
✤ Dry or wet?
✤ Optimal prep technique
✤ Effect of alcohol
✤ Physiological vs morphological effects
✤ Possibility of genetic sensitivity