Infection Control Standards in Anesthetic Practice

Abstract

Summary I t is important to minimize infection risk, in order to ensure that the practice of anesthesia is as safe as possible for patients, anesthetists and other health care workers. (1) Control of infection risk to patient: Measures followed to protect patients against acquiring infections through anesthesia procedures, either related to invasive procedures or potential risks related to air way management, in both situations, the appropriate levels of sterility or disinfection or decontamination are applied to all used equipments. Hand washing by anesthesia personnel is the most important infection control measure. Hands should be washed before touching a new patient or equipment to be used for a new patient, after leaving a patient, before an invasive procedure and whenever they become contaminated. Gloves are to be removed after procedures to minimize the contamination of the work place. Hands should be washed before and after the use of gloves.

(2) Invasive procedures 1- Peripheral venous catheterization: The site of the cannula is a potentially portal for entry of micro-organisms into subcutaneous tissues and circulation. So, the anesthetist’s hands must be washed and protective clean gloves should be worn. The skin should be disinfected with an appropriate preparation prior to cannulation. Cannulation should be performed in a manner remains the tip and the shaft of the cannula sterile. (3) Central venous catheterization The insertion of central venous and pulmonary artery catheters carries added infection hazards for the patient. Cannulation of central veins is to be performed using full aseptic technique including wearing of a surgical face mask, a sterile gown, sterile surgical gloves and the use of a sterile field bordered by sterile drapes. (4) Regional anesthesia When regional blocks are being performed, the hands should be washed and gloves worn, the skin at site of injection should be disinfected with a suitable preparation and the procedure done in such a way that remains the needle sterile. When a central nerve block is being performed or when a regional anesthesia catheter is to be left, full aseptic technique as mentioned before should be followed up. Single use (disposable) items: Items of airway equipments to be placed in direct contact with respiratory tract such as endotracheal tube and guedel airway which are labeled by the manufacturers as disposable or (for single use only) should not be reused. Devices to be sited in the upper airway and devices passing through the mouth or nose will become contaminated in the upper airway. Endotracheal tubes and nasal or pharyngeal airways should be kept sterile until be used. Reusable items - Reusable face masks must be decontaminated and then undergo disinfection prior to each use. - It is not necessary to package these items separately while they wait for next use. - The laryngeal masks are to be sterilized before use. - Laryngoscope handles should be decontaminated between uses.

The breathing circuits For each patient the breathing circuits should have been decontaminated and disinfected or protected by the use of new bacterial filters. Hospital infections of the respiratory tract are an important cause of morbidity and mortality. Most of them are lower respiratory tract infections (16% of all nosocomial infections In USA) Risk factor such as chronic obstructive pulmonary disease COPD, diabetes, advanced age and duration of the operation.