Infection associated with central venous or epidural catheters: how to reduce it?
OBJECTIVE
Central venous catheters are a leading source of nosocomial bloodstream infection with an estimated 10% mortality. Infection associated with epidural catheterization is an uncommon but devastating complication. Diagnosis of spinal epidural abscess requires a high index of suspicion and imaging techniques such as MRI. Early diagnosis and treatment will minimize permanent damage, but primary prevention should be the aim, which depends on proper patient evaluation and use of full aseptic precautions.


RESULTS
Recent studies suggest that epidural infection is no longer as rare a complication as once thought and may be increasing. It is not clear whether this increase is related to an increase in reporting, an overall increase in the total number of epidurals (especially extended use) being performed, or a true increase in infection rate. Implementation of multistep prevention programs has been shown to decrease central venous catheter-related bloodstream infection rate. Antiseptic or antibiotic-impregnated central venous catheters are effective in decreasing central venous catheter-related bloodstream infections.


CONCLUSIONS
Healthcare worker education and training are essential to create standardization of aseptic care. Continuous surveillance is necessary for identifying lapses in infection-control practices.
Ranasinghe
J Sudharma
JS
Department of Anesthesiology, Jackson Memorial Medical Center, University of Miami, Miller School of Medicine, Miami, Florida, USA.
Lee
Allison J
AJ
Birnbach
David J
DJ
D000767:Anesthesia, Epidural / Q000592:standards*; D001207:Asepsis / Q000379:methods / Q000592:standards*; D002404:Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D012307:Risk Factors