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COMPARISON OF SKIN DISINFECTANTS FOR PARTURIENT EPIDURALS

Department of Anesthesia, Royal University Hospital, 103 Hospital Drive, Saskatoon SK S7N 0W8

INTRODUCTION

Chlorhexidine as an antiseptic solution for placement of intravascular catheters decreases incidence of central line colonization and blood stream infection when compared to povidone-iodine ^1,2. The low incidence of infection following lumbar epidural analgesia/anesthesia (LEA) makes its use as an endpoint impractical; however when infection occurs, the consequences can be devastating. Reducing skin contamination should logically reduce risk of infectious complications. This prospective, randomized, controlled trial was designed to compare efficacy of skin asepsis using povidone-iodine with chlorhexidine in the parturient population.

METHODS

A convenience sample of accessible patients meeting inclusion criteria was used. Eligible participants were parturients over age 18 presenting as outpatients requesting LEA. Exclusion criteria were known allergy to either solution, antibiotic administration prior to placement of LEA, and immunosuppression of the patient. Sample size calculation was performed. A 30% positive culture rate using povidone-iodine has been reported in the literature³. A 50% reduction in positive culture rate² can be detected with 80% power at a one-tailed significance of 5%. A total of 300 parturients will be enrolled.

Following IRB approval and informed consent, patients were randomized via computer-generated random tables to receive skin preparation with 2% chlorhexidine or 10% povidone-iodine. Following standardized skin preparation with one of the two solutions, and prior to LEA placement, a skin swab was collected from the proposed LEA site. Data collection included parturient’s age, level of operator (resident vs. attending) and compliance with protocol.

RESULTS

To date, culture analysis has been reported on 248 of a planned 300 samples. Only 3 positive cultures have been reported; the study remains blinded.

DISCUSSION

It is likely no difference will be found between the two solutions. The significant difference between rates reported in the literature and our observed rate at a Canadian Teaching Hospital needs to be examined.

REFERENCES

1 Lancet 338: 339–43

2 Ann Intern Med 136: 792–801

3 Anesthesiology 88: 668–72

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Stewart, K. I Articles by Campbell, D. C Search for Related Content PubMed Articles by Stewart, K. I Articles by Campbell, D. C