ASRA Pain Medicine Releases Groundbreaking Infection Control Guidelines for Pain Management

Infection control guidelines for pain management

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Infection control has long been a cornerstone of effective health care, especially in fields like regional anesthesia and pain medicine. The American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) has unveiled new consensus practice infection control guidelines to enhance patient safety and outcomes to address this critical need. Developed over 4 years by a team of 22 authors, this comprehensive guide covers infection prevention, identification, and management across a spectrum of pain-related procedures.

During a recent webinar hosted by Newswise, David Provenzano, MD, the president of ASRA Pain Medicine; and Christine Hunt, DO, a pain physician at the Mayo Clinic in Florida, outlined the significance of these guidelines.

Hunt said, “Dr Provenzano [has] led an unbelievable effort to develop these guidelines. I want to mention these are important because when it comes to having a true consensus on identification, prevention, identification, and management of infection as a field, we need to go together. We are a multidisciplinary field, a strength of ASRA pain medicine, and a multidisciplinary Pain Society. As such, you know, we want to make sure that we're being proactive in terms of when infections do happen again; fortunately, although rare, when they do happen, having a consensus way of making sure we're dealing with those appropriately when it comes to the identification of infection, these guidelines do provide sort of what are their classic signs and symptoms that practitioners might expect to see.”

Hunt continued, “This is very helpful for physicians, advanced practice practitioners like your physician's assistants…and nurses. This is designed to be comprehensive and accessible, so the range of presentation will vary; as Dr Provenzano mentioned, this covers a variety of pain interventions, from single-shot nerve blocks to joint injections to implantable pain therapies.

The guidelines encompass over 80 critical questions and feature over 600 references, serving as an invaluable resource for clinicians. They address procedures ranging from regional anesthesia and nerve blocks to more invasive interventions like implantable pain therapies, such as spinal cord stimulators and intrathecal pumps.

“The scope of these current recommendations extends beyond neuraxial blocks and includes various nerve blocks (peripheral and spinal), chronic pain procedures, and minimally invasive surgical techniques used in acute and chronic pain management,” the authors of the guidelines wrote. “Where relevant and appropriate based on current evidence, recommendations from WHO [World Health Organization], CDC, NICE [National Institute for Health and Care Excellence], SCIP [Strategic Consortium of Intelligence Professionals], NACC [National Alzheimer’s Coordinating Center], and other guidelines have been considered and their significance mentioned for infection prevention in practices for the operating room (OR), regional anesthesia, and interventional chronic pain management.”

KEY COMPONENTS OF THE GUIDELINES

Prevention as the Cornerstone

Provenzano emphasized that following best practices could prevent approximately 50% of surgical site infections. The guidelines provide detailed recommendations on preoperative, intraoperative, and postoperative infection prevention strategies. These include weight-based antibiotic dosing to ensure efficacy and guidelines on the timing and duration of antibiotic use, which are crucial to combating antibiotic resistance.

Recognizing and Managing Infections

As Hunt highlighted, "Prompt identification and management of infections are paramount to minimizing morbidity." The guidelines describe recognizing subtle infection signs that might not include traditional symptoms like fever. For example, localized redness or swelling at a catheter or implant site could be early indicators. Clinicians are advised to act swiftly by removing infected devices and initiating targeted antibiotic therapy to prevent complications like sepsis or paralysis.

Comprehensive Coverage Across Procedures

The guidelines cover diverse pain management interventions. They address nerve blocks and epidural catheter use for acute pain, emphasizing the importance of recognizing early infection signs. They also provide detailed protocols for implantable devices for chronic pain, including spinal cord stimulators and pain pumps. By offering evidence-based advice for each scenario, the guidelines ensure clinicians are well-prepared for any infection-related challenge.

Impact on Patient Outcomes and Health Care Costs

Hunt elaborated on the patient experience, noting that infections can significantly impact the quality of life, especially when devices like spinal cord stimulators must be removed. The economic burden is equally staggering, with surgical site infections costing the US health care system approximately $3 billion annually. The guidelines aim to mitigate these costs by promoting effective infection prevention and management strategies.

Addressing Antibiotic Resistance

Antibiotic resistance remains a pressing global health issue, and the guidelines advocate for judicious antibiotic use. Provenzano explained, "Antibiotics must be used appropriately and timed correctly to maximize their effectiveness while reducing the risk of resistance." The guidelines stress preoperative dosing as the most effective strategy and discourage prolonged postoperative antibiotic use unless warranted by clinical indications.

Multidisciplinary Collaboration

One of the strengths of the guidelines is their multidisciplinary approach. ASRA Pain Medicine brings together professionals from various specialties, including anesthesiology, neurosurgery, and emergency medicine. This collaborative effort ensures the guidelines are practical and applicable across diverse clinical settings.

Practical Accessibility

The guidelines will be published in the premier journal Regional Anesthesia and Pain Medicine and available on the ASRA Pain Medicine website. This accessibility ensures that health care professionals worldwide can integrate these best practices into their daily routines.

Final Thoughts

Hunt and Provenzano emphasized this project's collaborative and patient-centered nature. Hunt remarked, "These guidelines are a labor of love, designed by clinicians for clinicians, to improve safety and quality of care." Provenzano added, "We are optimistic that this will set a new standard in infection control for pain management."

For infection preventionists, anesthesiologists, and other health care professionals, these guidelines represent a critical step forward in safeguarding patient health while addressing the growing challenges of antibiotic resistance and infection management. As elective pain procedures evolve, these guidelines will play a pivotal role in ensuring that patient care remains innovative and safe.