Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Sep 2008
ReviewTransfusion-transmissible infections and transfusion-related immunomodulation.
The risk of acquiring a transfusion-transmitted infection has declined in recent years. However, after human immunodeficiency virus and hepatitis B and C virus transmission were successfully reduced, new pathogens are threatening the safety of the blood supply, especially in the face of rising numbers of immunocompromised transfusion recipients. ⋯ The precise pathomechanism still remains uncertain; however, its mostly deleterious effects--such as a higher incidence of postoperative or nosocomial infections--is increasingly accepted. Although transfusion-related immunomodulation is thought to be mediated mainly by donor white blood cells, the benefit of leukoreduction on overall mortality and on infectious complications is highly debatable.
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Deep sternal wound infections (DSWI) continue to be a relatively uncommon event occurring in about 1%-2% of all patients undergoing cardiac surgery. However, the sheer number of cardiac surgery patients and the relatively high mortality associated with DSWIs makes them of clinical relevance. This review will describe the current incidence of DSWIs and their associated morbidity and mortality as well as risk factors for the development of this complication. The microbiology of DSWIs will be reviewed and strategies to prevent these complications will be discussed with a focus on interventions that may be undertaken by the clinical anesthesiologist.
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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.
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Best Pract Res Clin Anaesthesiol · Sep 2008
ReviewBioterrorism and the anaesthesiologist's perspective.
The use of non-conventional agents aimed at causing panic and terror among civilians has a long history. There have been uninterrupted threats and the use of biological and chemical weaponry from the time of early tribal conflicts to the Iran-Iraq war. ⋯ This chapter reviews the main chemical and biological agents possibly obtainable by individuals and groups, and the anaesthesiologist's tasks during the resultant non-conventional multi-casualty scenarios. It briefly illustrates the chemical and biological pathological effects of the various intoxicants on the human body, and describes modes of protection and the currently available treatment, based on both military and civilian materials and on the authors' own experience derived from specially designed drills.
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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.