ASRA Pain Medicine consensus practice infection control guidelines for regional anesthesia and pain medicine.

Background: To provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management.

Methods: Following board approval, in 2020 the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) commissioned evidence-based guidelines for best practices for infection control. More than 80 research questions were developed and literature searches undertaken by assigned working groups comprising four to five members.

Importance of Ultraviolet-C (UV-C) Emitter Configuration for the Attenuation of Staphylococcus aureus and Candida auris Pathogens.

Background: The relative importance of different ultraviolet-C (UV-C) emitter configurations on the attenuation of vegetative bacterial and fungal pathogens has not been assessed. We hypothesized that emitter configuration would impact the efficacy of UV-C attenuation of and ( pathogens.

Methods: American Type Culture Collection (ATCC) (ATCC 6538) and (ATCC MYA-5001 carriers (ReadyNowTM Test Carriers, Stratix Labs Corporation, Saint Paul, MN) were mounted on an aluminum stand along with three calibrated radiometers (International Light Technologies model ILT1270, Peabody, MA).

Importance of Ultraviolet-C (UV-C) Emitter Configuration for Clostridioides difficile Attenuation.

Background: The impact of ultraviolet-C (UV-C) emitter configuration on pathogen attenuation has not been assessed. We hypothesized that emitter configuration would impact UV-C efficacy for () attenuation.

Methods:  carriers (ReadyNow Test Carriers, Stratix Labs Corporation, Saint Paul, MN) inoculated with > 10 American Type Culture Collection (ATCC) 43593 (according to American Society for Testing and Materials (ASTM) 3135 standards) were obtained, and the following experiments were conducted from April to August of 2023.

A Randomized Placebo-Controlled Trial of Leronlimab in Mild-To-Moderate COVID-19.

Purpose: Early in the course of the SARS-CoV-2 pandemic it was hypothesised that host genetics played a role in the pathophysiology of COVID-19 including a suggestion that the CCR5-Δ32 mutation may be protective in SARS-CoV-2 infection. Leronlimab is an investigational CCR5-specific humanized IgG4 monoclonal antibody currently in development for HIV-1 infection. We aimed to explore the impact of leronlimab on the severity of disease symptoms among participants with mild-to-moderate COVID-19.

Frequently Touched Sites in the Intensive Care Unit Environment Returning 100 Colony-Forming Units per Surface Area Sampled Are Associated With Increased Risk of Major Bacterial Pathogen Detection.

Background: A threshold for surface hygiene has not been defined for the healthcare arena. We aimed to identify the magnitude of bacterial contamination of frequently touched sites in the intensive care unit (ICU) environment that could be used to guide quality improvement initiatives.

Methods: Nineteen patients in a mixed ICU environment (providing care for medical and surgical patients) were followed from admission for 72 hours in 2010.

Surface Cleaning with a Microfiber Cloth and Water followed by Ultraviolet-C Light Exposure Achieves Non-Inferior Disinfection of a Pathogenic Staphylococcus aureus Strain versus Use of Germicidal Wipes.

Background: We hypothesized that ultraviolet-C (UV-C) irradiation (Surfacide, Waukesha, WI) following use of microfiber cloths (Sanny Shop LLC, Longmont, CO) soaked in water would be noninferior to surface disinfection wipes containing a quaternary ammonium compound and alcohol (PDI Healthcare, Woodcliff Lake, NJ) for the pathogenic () sequence type 5 (ST5).

Methods: This was a randomized laboratory study of disinfection approaches for  ST5. A total of 270 polycarbonate slides loaded with ST5 were prepared for the standard surface disinfection group (N=18) and water-soaked microfiber cloths and UV-C treatment group (N=144), along with positive and negative microbiological controls.

Placebo response in patients with Dravet syndrome: Post-hoc analysis of two clinical trials.

Objective: Dravet syndrome is a rare, early childhood-onset epileptic and developmental encephalopathy. Responses to placebo in clinical trials for epilepsy therapies range widely, but factors influencing placebo response remain poorly understood. This study explored placebo response and its effects on safety, efficacy, and quality of life outcomes in patients with Dravet syndrome.

Dravet syndrome seizure frequency and clustering: Placebo-treated patients in clinical trials.

Objective: Dravet syndrome is a rare developmental epilepsy syndrome associated with severe, treatment-resistant seizures. Since seizures and seizure clusters are linked to morbidity, reduced quality of life, and premature mortality, a greater understanding of these outcomes could improve trial designs. This analysis explored seizure types, seizure clusters, and factors affecting seizure cluster variability in Dravet syndrome patients.

A threshold of 100 or more colony-forming units on the anesthesia machine predicts bacterial pathogen detection: a retrospective laboratory-based analysis.

Purpose: Preventing the spread of pathogens in the anesthesia work area reduces surgical site infections. Improved cleaning reduces the percentage of anesthesia machine samples with ≥ 100 colony-forming units (CFU) per surface area sampled. Targeting a threshold of < 100 CFU when cleaning anesthesia machines may be associated with a lower prevalence of bacterial pathogens.

The relative efficacy of multiple syringe tip disinfection techniques against virulent staphylococcus contamination.

Background: A recent study confirmed significant contamination of syringe tips following routine anaesthesia practice of at least 6 h in duration.

Aim: We assessed the relative efficacy of clinically relevant syringe tip disinfection techniques following contamination with the hyper transmissible and more pathogenic Staphylococcus aureus sequence type 5 (S. aureus ST5) strain characteristic associated with increased strength of biofilm formation and greater desiccation tolerance.

Estimation of the contribution to intraoperative pathogen transmission from bacterial contamination of patient nose, patient groin and axilla, anesthesia practitioners' hands, anesthesia machine, and intravenous lumen.

Background: Earlier studies showed net cost saving from anesthesia practitioners' use of a bundle of infection prevention products, with feedback on monitored Staphylococcus aureus intraoperative transmission. ESKAPE pathogens also include Enterococcus and gram-negative pathogens: Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter. We evaluated whether bacterial contamination of patient nose, patient groin and axilla, anesthesia practitioners' hands, anesthesia machine, and intravenous lumen all contribute meaningfully to ESKAPE pathogen transmission within anesthesia work areas.

Characterizing the molecular epidemiology of anaesthesia work area transmission of Staphylococcus aureus sequence type 5.

Background: Staphylococcus aureus sequence type 5 (ST5) is an emerging global threat.

Aim: To characterize the epidemiology of ST5 transmission in the anaesthesia work area.

Methods: The retrospective cohort study analysed transmitted, prophylactic antibiotic-resistant Staphylococcus aureus isolates involving anaesthesia work area reservoirs.

Most hospital patients at risk for bacterial infection undergo an anesthetic: implications for infection control practices related to the anesthesia workspace.

Purpose: Even with nearly 100% compliance with prophylactic antibiotic protocols, many surgical patients (> 5%) develop surgical site infections, some caused by pathogens transmitted from the anesthesia workspace (e.g., anesthesia machine), including multidrug-resistant Staphylococcus aureus.

Quantifying and Interpreting Inequality in Surgical Site Infections per Quarter Among Anesthetizing Locations and Specialties.

Background Earlier studies have shown that prevention of surgical site infection can achieve net cost savings when targeted to operating rooms with the most surgical site infections. Methodology This retrospective cohort study included all 231,057 anesthetics between May 2017 and June 2022 at a large teaching hospital. The anesthetics were administered in operating rooms, procedure rooms, radiology, and other sites.

Transmission of Staphylococcus aureus in the anaesthesia work area has greater risk of association with development of surgical site infection when resistant to the prophylactic antibiotic administered for surgery.

Background: The extent to which the transmission of prophylactic-antibiotic-resistant bacteria from the anaesthesia work area increases the risk of surgical site infection (SSI) is unknown. It was hypothesized that the risk of SSI would increase progressively from no transmission to transmission of prophylactic-antibiotic-resistant isolates.

Methods: This was a retrospective analysis of archival samples collected in two previously published studies with similar inclusion criteria and sample collection methodology (observational study 2009-2010 and randomized trial 2018-2019).

Epidemiology of Enterococcus , Staphylococcus aureus , Klebsiella , Acinetobacter , Pseudomonas , and Enterobacter Species Transmission in the Pediatric Anesthesia Work Area Environment With and Without Practitioner Use of a Personalized Body-Worn Alcohol Dispenser.

Background: Personalized body-worn alcohol dispensers may serve as an important tool for perioperative infection control, but the impact of these devices on the epidemiology of transmission of high-risk Enterococcus , Staphylococcus aureus , Klebsiella, Acinetobacter , Pseudomonas , and Enterobacter (ESKAPE) pathogens is unknown. We aimed to characterize the epidemiology of ESKAPE transmission in the pediatric anesthesia work area environment with and without a personalized body-worn alcohol dispenser.

Methods: This controlled before and after study included 40 pediatric patients enrolled over a 1-year study period.

The efficacy of multifaceted versus single anesthesia work area infection control measures and the importance of surgical site infection follow-up duration.

Background: Earlier a randomized trial showed efficacy of a multifaceted intervention approach for reducing surgical site infection: hand hygiene, vascular care, environmental cleaning, patient decolonization (nasal povidone iodine, chlorhexidine wipes), with feedback on pathogen transmission. The follow-up prospective observational study showed effectiveness when applied to all operating rooms of an inpatient surgical suite. In practice, many organizations will at baseline not be using conditions equivalent to the control groups but instead functionally have had ongoing a single intervention for infection control (e.

Patient Safety in Anesthesia: Hand Hygiene and Perioperative Infection Control.

Purpose Of Review: This review highlights the importance of the anesthesia team in minimizing perioperative infection risks and prevention of surgical site infection. Due to the immense financial and patient care burden that results from perioperative infection, a foundational knowledge in preventive measures is essential.

Recent Findings: Perioperative infection control, the role of the anesthesia team in reducing infection risk, and more specifically the outsized importance of hand hygiene in this space have become increasingly apparent.

Molecular characterisation and epidemiology of transmission of intraoperative isolates stratified by vancomycin minimum inhibitory concentration (MIC).

Background: Reduced vancomycin susceptibility in () is considered a more pathogenic strain characteristic and is associated with treatment failure. We aimed to characterise the epidemiology of intraoperative transmission of isolates with reduced vancomycin susceptibility.

Methods: isolates (N=173) collected from 274 randomly selected operating room environments at three major academic medical centres in 2009-2010 were characterised by vancomycin minimum inhibitory concentration (MIC).

Estimating costs of anesthesia supplies for intraoperative infection control.

Background: Some costs for anesthesia supplies to reduce intraoperative infections depend on the procedure and duration of the case. For regular anesthesia supplies and medications, costs are linearly related to American Society of Anesthesiologists' Relative Value Guide units, known for nearly all cases in the United States of America. We hypothesized linear association between costs of infection control items and anesthesia units.