this field has so many other issues of concern - id personally think that a consensus approach would be most beneficial for Pain Medicine as a whole, so we dont get black eye from this aspect. lord knows we have enough issues regarding opioids, steroid injections, nerve blocks, etc to bury the field.
regardless, info is from a lecture by Therese Horlocker, from Mayo Clinic. its actually from 2012 - i initially thought it was from 2009. the 20 reported incidences were in a MMWR dated July 13, 2012.
One of the key studies she quotes is from Moen, 2004, Sweden. 1.2 million spinals, 450k epidurals. 29 cases of meningitis, frequency of 1:53000, one department apparently had 1:3000 incidence rate.
Another slide: break in aseptic technique lead to 4 confirmed and 5 suspected bacteremia following SI injections - sacroiliac, not S1.
in New York, 3 cases of spinal meningitis in 2008. In ohio, 2 cases. both clusters were with single anesthesiologist, Ohio one didnt wear mask.
Arizona pain clinic in 2010- MRSA related to use single dose vial for ESI/SGB.
Ortho clinic Delaware 2012 - 7 pts. hosp with MRSA from multiple use of single dose bupiv bottle for joint injections.
Morbidity Mortality Review - Grand rounds May 31, 2013:
Since 2001, at least 49 outbreaks have occurred because of extrinsic contamination of injectable medical products at the point of administration (3; CDC, unpublished data, 2013). Twenty-one of these outbreaks involved transmission of HBV or HCV; the other 28 represented outbreaks of bacterial infections, primarily invasive bloodstream infections. Approximately 90% of these known outbreaks occurred in outpatient settings. Pain management clinics, where injections often are administered into the spine and other sterile spaces using preservative-free medications, and cancer clinics, which typically provide chemotherapy or other infusion services to patients who might be immunocompromised, are represented disproportionately relative to the overall volume of outpatient care.
Several states are addressing the public health issue of unsafe injection practices, including New York. Since 2002, the New York State Department of Health (NYSDOH) has conducted 11 investigations of known or potential bloodborne pathogen transmissions that involved notification of nearly 10,000 persons (NYSDOH, unpublished data, 2012). The predominant modes of exposure or transmission discovered were related to unsafe injection practices similar to those described in the Nevada outbreak.
MMWR July 13, 12 was discussed previously, and on at least one separate thread.
Since 2007, the year that injection safety was included as part of Standard Precautions, 20 outbreaks associated with use of single-dose or single-use medications for more than one patient have been reported (1; CDC, unpublished data, 2012).
www.cdc.gov
pubmed.ncbi.nlm.nih.gov
