Prevention of Infection in Epidurals and Spinals
Abstract Number: 38
Abstract Type: Other
Neuraxial blockade can cause life threatening complications. Safe insertion and management requires detailed knowledge. A national audit in the UK showed that complications secondary to infection caused by these techniques led to 20 cases of abscess formation and 6 cases of meningitis last year(1). Aseptic precautions prior to these procedures are paramount to avoid infection, but there seems to be considerable variation in techniques.
METHOD An anonymous audit was conducted amongst all grades of anaesthetists at East Surrey Hospital, in December 2009, to ascertain techniques and knowledge of infection prevention in neuraxial blockade.
RESULTS 78% responded. Of these, 48.5% were Consultants, 45% Associate Specialists, Registrars, Speciality Doctors, Other, 6.5% CT1 and CT2. Questions and results are available in table 1.
DISCUSSION There is a wide variety in management and insertion techniques of neuraxial blockade. Infection may have extreme consequences. It would be sensible to direct efforts at minimising sources of infection whenever performing these techniques. We recommend the following to reduce the chance of getting a secondary infection.
1) Make surgical scrub available wherever neuraxial blockade is administered. 2) When siting an epidural hat, gown, gloves, mask, sterile drapes and 0.5% Chlorhexidene should be used(2, 3). 3) Attach a filter to epidurals at insertion. 4) When a filter becomes detached, the catheter should be cleaned with 0.5% Chlorhexidene solution, a 10cm length of catheter should be aseptically removed and a new filter should be connected(4). 5) If the epidural detaches from the back, then the catheter should be removed and be re-sited. 6) When using an opioid, the neck of the ampoule should be wiped with an alcohol swab before opening and should be drawn up using a filter needle(5).
References 1) NAP3. Royal College of Anaesthetists, January 2009. 2) Good Practice in the management of continuous epidural analgesia in the hospital setting. AAGBI November 2004. 3) The Importance and Implications of Aseptic techniques during regional anaesthesia. J Hebl Reg An and Pain Med, 31, 4, 2006, p311-323. 4) Management of disconnection between epidural filters and catheters: a dilemma for the anaesthetist. T Donnelly. Anaesthesia, 2000,55, p192-193. 5) The effect of alcohol swabs and filter straws on reducing contamination of glass ampoules used for neuraxial injections. C Hemingway et al. Anaesthesia, 2007,62. p286-288