INFECTION CONTROL

III. GENERAL PRINCIPLES OF ANESTHESIA

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ASEPTIC TECHNIQUE

AGENT	DESCRIPTION AND RECOMMENDATIONS
Chlorhexidine	· Preferred skin prep -Immediate action, residual activity. Effective against a variety of microbes · Tends to bind to tissues, extending action · Effective in presence of blood/organic material · Limited sporicidal · Do not use on eyes, ears, brain and spinal tissues, mucus membranes, or genitalia · Concentrations > 0.5% NOT recommended for epidurals/spinals
Povidone-Iodine	· Alternative to chlorhexidine, if contraindicated · Effective against a wide range of microbes and acts immediately · Safe for face, head, mucus membranes, vagina, and neuraxial · Less persistent than chlorhexidine and limited residual · Decreased effectiveness in blood/organic matter
Parachoroxylenol	· Less effective than chlorhexidine and povidone · Moderate against a broad range of microbes · Moderate persistent/residual · Nontoxic with no tissue contraindications · Remains effective in presence of blood/organic material
Iodine-base with alcohol	· Highly effective against broad range of microbes · Acts immediately · Highly flammable

Heat and moisture exchangers alone are NOT effective in decreasing the transmission of microbes to the anesthesia breathing system.

Creutzfeldt-Jakob disease
- Dispose and destroy equipment when appropriate
- Clean and perform steam sterilization of instruments for 30-60 minutes at 132^O Other options available.

Tuberculosis
- Place a high-efficiency particulate air (HEPA) filter between the breathing system and patient.

The choice to reconnect an epidural catheter that has been accidentally disconnected is at the provider’s discretion or facility policy. When a disconnected catheter is discovered and fluid has moved more than five inches from the disconnected end, the catheter should be removed.

NEEDLE SAFETY

Safe injection guidelines
- Never reuse a needle.
- Never refill a syringe once it has been used.
- Never use an infusion or IV administration tubing set for more than one patient.
- Never reuse a syringe/needle to withdraw medication from a multidose vial (MDV).
- Avoid use of MDV for more than one patient.
- Do not access an MDV in the immediate patient treatment area.
- Never reenter a single dose vial.
- When accessing medication vials, complete hand hygiene, don clean gloves, use a new sterile needle, and cleanse the access with 70% alcohol prior to needle insertion.
Prevent coring and particulate contamination by applying in-line filtration using a 45 µ rater.

Clinical Practice Resources; Infection Prevention and Control

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