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Hand washing technique for epidurals - Effect on reduction of contamination risk
Abstract Number: T-31
Abstract Type: Original Research
Introduction: Infection associated with neuraxial anesthesia and analgesia may result in rare but devastating morbidity and mortality, however, there is no current literature containing best practice guidelines for hand sanitizing measures in this context. Results from previous work demonstrate bacterial transmission from the operator’s bare forearms to the epidural equipment implying possible contamination of the epidural space. This is may be true where gowning is not used, when performing labor epidurals. These findings underscore the need to examine the most effective method of hand and arm sterilization before performing epidural anesthesia. The objective of this study was to compare the growth of microbial organisms on the operators forearm, between 3 common techniques of hand washing before placing labor epidurals.
Methodology: This was a prospective observer blinded randomized controlled trial. Informed written consent was obtained from all participating epidural practitioners. There were three groups consisting of the most common variants of current practice at our institution:
A) Alcohol gel alone upto elbows, B) Hand washing with soap upto elbows, sterile towel to dry, C) Hand washing with soap upto elbows, non-sterile towel to dry, followed by alcohol gel.
There were a further two sub-groups analyzed for completeness
D) Hand washing upto elbows, non-sterile towel to dry (interim sample from C)
E) Hand washing upto elbows, sterile towel to dry, followed by alcohol gel (follow on sample from B)
Power analysis revealed a necessary sample size of 300. Specimens were obtained from a 5cm² area on the inside aspect of the middle segment of each of the participants’ forearms. Swabs were coded and cultures were immediately performed by a blinded microbiologist. Bacterial growth was studied for up to 72 hours.
Results: We found colonization rates to be 4%, 25% and 16% in groups A, B and C respectively on one or both arms. Compared to group A, the odds ratio of bacterial growth was 8.00 for group B (P<0.001) and 4.57 with group C (P=0.009).
Discussion. The findings of this study attest to the superiority of alcohol gel use in reducing bacterial growth. These results may enable us to develop guidelines and protocols in order to standardize and improve hand-sanitizing practices amongst epidural practitioners.
Reference:1) Anesthesiology 2004; 101:9 2) Br J Anaesth. 2009;102:179–190; 3) Anaesthesia 2002; 57:593–6