Abstract # 143: Responding to the ASRA (American Society of Regional Anesthesia) Challenge ›ÛÒ Should Gowning be the Standard of Practice for Epidural Anesthesia: A Randomized Control Trial

143 Responding to the ASRA (American Society of Regional Anesthesia) Challenge – Should Gowning be the Standard of Practice for Epidural Anesthesia: A Randomized Control Trial Abstract Type: Original Research Naveed T. Siddiqui, M.D.; Zeev Friedman, M.D.; Allison McGeer, M.D, F.R.C.P.C.; Jose CA Carvalho, M.D., Ph.D., F.A.N.Z.C.A., F.R.C.P.C.; Sharon Davies, M.D., F.R.C.P.C. Mount Sinai Hospital, University of TorontoType: Original Research Naveed T. Siddiqui, M.D.; Zeev Friedman, M.D.; Allison McGeer, M.D, F.R.C.P.C.; Jose CA Carvalho, M.D., Ph.D., F.A.N.Z.C.A., F.R.C.P.C.; Sharon Davies, M.D., F.R.C.P.C. Mount Sinai Hospital, University of Toronto Introduction: Recent data suggest that the incidence of infectious complications secondary to neuraxial anesthesia is higher than previously thought (1, 2), and breaches in aseptic technique during the procedure may be an important contributing factor. The American Society of Regional Anesthesia has identified a lack of randomized controlled trials on the topic, particularly in respect to gowning for the procedure. We hypothesized that contamination of epidural equipment and colonization of the epidural catheter will be increased if sterile gowns are not worn. Methods: After REB approval and informed consent, pregnant women in labor requesting analgesia were randomized to undergo epidural catheter insertion with the anesthesiologist either wearing a sterile gown or not wearing a sterile gown. All the other components of aseptic technique, such as hand washing and the antiseptic solution (2% chlorhexidine with 70% alcohol), were standardized. A total of 5 cultures were obtained in each case: 2 from the operator’s forearms after completion of the hand wash (either from the bare forearm or from the gown), 1 from a sterile Agar plate placed in the working area, and 2 from the epidural catheter after the delivery (one at 10 cm from the skin and one at the distal tip). The outcomes were the growth of any microorganism and the identification of the same pathogen at all the cultured sites. The microbiologists handling the specimens were blinded to the group allocation. Results: Two hundred and forty patients were randomized. Physicians who were gowned had a significantly lower number of positive cultures from the forearms (<0.001). However, there were no significant differences in culture rates from either the catheter or the work area (Table). The most common microorganism isolated in both groups was coagulase negative Staphylococcus, followed by the Bacillus species. In most cases, the microorganisms identified on the epidural tip were not the same as those on the operator’s forearm. Discussion: Our results suggest that although the wearing of gowns may decrease the bacterial colonization of the forearms, it does not affect the contamination of the working area or growth on the epidural catheters. Much attention should be paid to hand washing techniques that may include the use of antiseptic and alcohol-based solutions on hands and forearms, extending up to the elbows. References: 1)Anesth Analg 2007;104: 965–74; 2) Br J Anaesth 2002;89: 778–82 Table. Number and percentage of positive culture in the studied groups No Gown (n=109) Gown (n=108) p-value Right Forearm 21 (19.3) 2 (1.9) <0.001 Left Forearm 21 (19.3) 1 (0.9) <0.001 Either Forearm 31 (28.4) 3 (2.8) <0.001 Working Area 21 (19.3) 12 (11.1) 0.130 Tip of catheter 10 (9.2) 14 (13.0) 0.396 Proximal from tip 17 (15.6) 20 (18.5) 0.593 Anywhere on catheter 22 (20.2) 26 (24.1) 0.517 Any location 56 (51.4) 38 (35.2) 0.020