[Hygiene standards for spinal anaesthesia]

Infections after performance of a spinal anaesthesia (SPA) are rare. Reports in the literature on the frequency of cases of meningitis that occur after a spinal anaesthesia vary between 3.7/100,000 and 7.2/100,000. Spinal abscesses after SPA have a calculated incidence of 1/1,260,000. However, such abscesses are often associated with serious consequences for the patient. Epidural/spinal abscesses can damage the spinal cord through compression or directly. Mortality is reported to range from almost 10% up to 16%. Prognostic factors for an unfavourable course are old age, the extent of spinal cord compression and the time between the onset of symptoms and the start of therapy. Paralyses that exist for less than 36 hours are associated with a better survival or, respectively, a better recovery of neurological functions. Altogether, only about 40% of the patients recover completely, the rest suffer from persisting neurological deficits. In 27% of the cases, the neurological deficits are severe. According to legislation, every institution has to have a hygiene plan or a hygiene SOP, also for the performance of SPA. In 2006 the scientific working group "Regional Anaesthesia" of the German Society for Anaesthesiology and Intensive Care Medicine (Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) published hygiene recommendations for the execution and further management of regional anaesthetic procedures that can be used for orientation. These recommendations are based to a large extent on guidelines of the Robert Koch Institute (RKI) for the prevention of infections associated with vessel catheters. When an infection occurs, a timely diagnosis with the help of MRI studies and, if necessary, liquor puncture as well as a rapid initiation of treatment is of decisive importance for the prevention of late squeals.