Aseptic techniques for labour epidurals: A survey and review of neuraxial anesthesia practice

Background: Aseptic technique is essential for the prevention of infection during labour epidural procedures. The literature suggests there is significant variability in aseptic practice among clinicians which often depends on personal beliefs rather than scientific evidence. The main objective of this survey was to determine which components of aseptic precautions in labour epidural anesthesia were considered essential by anesthesiologists. Methods: A self-administered questionnaire regarding commonly used aseptic techniques during epidural insertion was distributed via regular mail to 1047 practicing anesthesiologists in Ontario, Canada. Questions were formulated with assistance from community and university based obstetrical anesthesiologists. The survey focused on practice demographics, methods of asepsis during preparation, and aseptic technique during epidural insertion. Results: The response rate for this survey was 42% (40% were non-teaching and 60% academic physicians). The major findings revealed significant heterogeneity; 38% of respondents wore a sterile gown, 68% selected chlorhexidine gluconate as their ideal antiseptic, 32% used povidone iodine, and 78% did not consider the use of a filter needle essential to aseptic practice. Furthermore, while all respondents acknowledged hand-washing essential to aseptic practice, high variability regarding details of handwashing technique was evident between individuals. Significant differences in aseptic practice were also observed between non-teaching and teaching hospitals. Conclusion: Aseptic technique for labour epidural insertion varies among individuals and institutions.