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Survey of Skin Preparation Technique during Neuraxial Procedures
Abstract Number: 14
Abstract Type: Original Research
Objective: Assess the current practices and beliefs of a group of practitioners using skin cleanser solutions before neuraxial procedures such as lumbar puncture, spinal anesthesia or combined spinal and epidural anesthesia. There is controversy surrounding the negative effects of chlorhexidine on the spinal cord. The ideal skin preparation for neuraxial techniques is one which prevents infection with no measurable toxicity. Whereas previous studies have shown chlorhexidine to be a superior antiseptic compared to iodine based compounds, intrathecal neurotoxicity has not been studied. Furthermore, there is no FDA approved antiseptic solution for neuraxial techniques. The impact on clinical decision making has not been studied.
Methods: An anonymized, IRB approved survey was distributed to clinical care providers from the Department of Anesthesiology and Critical Care Medicine at the Johns Hopkins Hospital-Broadway performing neuraxial techniques. The survey asked respondents various questions pertaining to practices and perceptions of skin preparation compounds.
Results: A total of 151 respondents completed the survey; 60 residents, 64 attendings, and 27 CRNAs. Iodine-based solutions were preferred by 68% of all respondents. Most respondents polled (61%) believed that neither solution was a better antiseptic; 66% believed that neither was more toxic, and 14% and 19% believed that iodine or chlorhexidine respectively was more toxic.
Conclusions: The study shows that most respondents are not using the cleaning solution which has been shown in the literature to have superior bactericidal activity. While a number of practitioners believe that either iodine or chlorhexidine is toxic, evidence for chlorhexidine induced toxicity specifically during neuraxial technique is not available. Further studies are needed to more adequately evaluate for potential toxicity associated with the application of these skin cleansers.