Dept Of Anesthesiology & Critical Care, University Of Pennsylvania School Of Medicine

Indwelling Urinary Catheter presence for more than 2 days post operatively is associated with a higher risk of urinary tract infections

Wald et al reported a retrospective cohort study of 35,904 Medicare patients from 2,965 United States acute care hospitals who underwent major surgery (coronary artery bypass and other open cardiac operations, vascular surgery, general abdominal colorectal surgery, hip or knee joint arthroplasty) during 2001.  Eighty six percent of patients undergoing these major operations had perioperative indwelling urinary catheters.  Of these, 50% had their catheters for longer than 2 days post operatively.  Those patients with catheters for more than 2 days were twice as likely to a develop urinary tract infection than patients with catheterization of 2 days or less.  In addition post operative catheterization greater than 2 days was also associated with increased 30 day mortality, and decreased likelihood to be discharged home.  In their introduction the authors note that the risk of urinary tract infection is 5 to 10% per catheter day beyond the first 48 hours.  In their discussion the authors note that “among patients with urinary tract infection an estimated 3.6% will develop bacteremia – a condition that adds significantly to length of stay, and is a risk factor for death among elderly patients.”  Wald HL et al: Indwelling urinary catheter use in the postoperative period.  Analysis of the National Surgical Infection Prevention Project Data.  Arch Surg 2008;143:551-557

 

David S. Smith, M.D., Ph.D.

Multidose vials of anesthetics appear to be the most likely factor in transmission of hepatitis C between patients undergoing arthroscopy and endoscopy

The authors investigated two episodes of hepatitis C transmission between patients who underwent diagnostic procedures.  In both events the common factor appeared to be open multidose vials that had been used for several patients.  “In the arthroscopy episode the anaesthetist re-used the drawing up needle left in the ampoule and syringe to withdraw additional medication.  In the endoscopy episode a new needle and syringe were used every time the ampoules were accessed.  However it is possible in the second case that an open multi-dose vial of fentanyl left adjacent to the sharps container might have become contaminated.”  The authors strongly suggest the use of single dose containers.  If multidose containers must be used they suggest that the drugs be drawn up into individual syringes prior to the commencement of patient care and that this be done in a “clean” area remote from where the anesthesia care will be provided.  Tallis GF et al: Evidence of patient-to-patient transmission of hepatitis C virus through contaminated intravenous anaesthetic ampoules.  J Viral Hep 2003;10:234-239

 

David S. Smith, M.D., Ph.D.

Health care provider practices infect patients in outpatient settings

Over a 10 year period (1998 – 2008) health care practices resulted in 33 episodes (448 persons) of transmitting hepatitis B and hepatitis C in non hospital health care settings including outpatient clinics (12 outbreaks), hemodialysis centers (6 outbreaks) and long term care facilities (15 outbreaks).  “In the outbreaks involving outpatient clinics and several hemodialysis centers, the purported mechanism of patient to patient transmission was primarily syringe reuse or other infection control lapses that resulted in contamination of injectable medications or flush solutions.  In several outbreaks, single use medication vials (for example propofol) and bags of saline solution were inappropriately used for multiple patients.  Anesthesia delivery was a common factor in 6 outbreaks.” Thompson ND et al: Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998 – 2008.  Ann Intern Med 2009;150:33-39.

 

David S. Smith, M.D., Ph.D.