SKIN ANTISEPSIS PRACTICES FOR CENTRAL NEURAXIAL BLOCKADE
Keywords:
Skin Antisepsis, Neuraxial Anesthesia, Regional Anesthesia, Patient SafetyAbstract
Background: Skin antisepsis is essential before the central neuraxial blockade. Various antiseptic solutions are in clinical use, like povidone-iodine, alcohol, or chlorhexidine. This study was conducted to assess current practices for skin antisepsis before central neuraxial blockade and observe the compliance of anaesthesiologists with international standards in Teaching Hospitals in Karachi, Pakistan. Methods: A cross-sectional study was conducted on all anaesthesia faculty members, working in Teaching Hospitals in Karachi from March to May 2022. Demographic data included institutional setup and current position at the institution. The type of solution used for skin anti-sepsis for the central neuraxial blockade, method of application, and subsequent practices of anti-sepsis were asked. Recommendations for the skin anti-antisepsis and the reason for opting for their choice of solution and practices were also assessed. Stratification analysis was then performed to observe the effect modifiers of study variables. Results: Data from seventy faculty members were analyzed. Povidone-Iodine was the most frequent solution used for skin antisepsis. Alcohol-based Chlorhexidine 2% and 0.5% were the alternative choices. The application method prevalent was Sponge/swab with Gallipot (94.3%). Major reasons to opt for their choice of solution were personal preference, cost-effectiveness, and availability of the solution in their Institute. Fifty percent of physicians considered Chlorhexidine 2% as the recommended solution for central neuraxial procedures. Regarding sterility, over ninety percent adhered to the recommended practices. Conclusion: Povidone-Iodine is currently the most frequent solution used for skin antisepsis before central neuraxial blockade by anaesthesiologists. The recommended solution (Chlorhexidine) was not in clinical practice due to personal preference, cost-effectiveness, or unavailability.References
Pitkanen MT, Aromaa U, Cozanitis DA, Forster JG. Serious complications associated with spinal and epidural anaesthesia in Finland from 2000 to 2009. Acta Anaesthesiol Scand 2013;57(5):553–64.
Nysora. Infection control in regional anesthesia. [Internet]. 2022 [Cited 2023 Jun 4]. Available from: https://www.nysora.com/topics/complications/infection-control-regional-anesthesia/
Doan L, Piskoun B, Rosenberg AD, Blanck TJ, Phillips MS, Xu F. In Vitro Antiseptic Effects on Viability of Neuronal and Schwann Cells. Reg Anesth Pain Med 2012;37(2):131–8.
Campbell JP, Plaat F, Checketts MR, Bogod D, Tighe S, Moriarty A, et al. Safety guideline: skin antisepsis for central neuraxial blockade. Anaesthesia 2014;69(11):1279–86.
Center for Drug Evaluation and Research. [Internet]. 2020 [Cited 2020 July 19]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2018/208288Orig1s000MedR.pdf
Scott M, Stones J, Payne N. Antiseptic solutions for central neuraxial blockade: which concentration of chlorhexidine in alcohol should we use? Br J Anaesth 2009;103(3):456–7.
Association of Anaesthetists of Great Britain and Ireland; Obstetric Anaesthetists' Association; Regional Anaesthesia UK; Association of Paediatric Anaesthetists of Great Britain and Ireland; Campbell JP, Plaat F, Checketts MR, et al. Safety guideline: skin antisepsis for central neuraxial blockade. Anaesthesia 2014;69(11):1279–86.
Practice Advisory for the Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Techniques: An Updated Report by the American Society of Anesthesiologists Task Force on Infectious Complications Associated with Neuraxial Techniques and the American Society of Regional Anesthesia and Pain Medicine*. Anesthesiology. The American Society of Anesthesiologists; 2017. [Internet]. [Cited 2020 July 19]. Available from: https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2599857
Orr T, Wenham T, Kasa B. UK survey of skin antisepsis for neuraxial block. Anaesthesia 2015;70(4):503–4.
Creaney M, Mac Colgáin S. Antisepsis for neuraxial procedures in Irish obstetric units and its possible impact on patient safety. A survey of national practice and associated complications. Int J Obstet Anesth 2020;42:61–64.
Doan L, Piskoun B, Rosenberg AD, Blanck TJ, Phillips MS, Xu F. In vitro antiseptic effects on viability of neuronal and Schwann cells. Reg Anesth Pain Med 2012;37(2):131–8.
Bogod D. The sting in the tail: antiseptics and the neuraxis revisited. Anaesthesia 2012;67:1305–20.
Sutcliffe v Aintree Hospitals NHS Trust, [2008] EWCA Civ 179 | England and Wales Court of Appeal (Civil Division), Judgment, Law, casemine.com. [Internet]. [cited 2023 June 16]. Available from: https://www.casemine.com/judgement/uk/5a8ff7a660d03e7f57eb0c8b
Killeen T, Kamat A, Walsh D, Parker A, Aliashkevich A. Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review. Anaesthesia 2012;67:1386–94.
Kaliappan A. Arachnoiditis: capillary action and chlorhexidine. Anaesthesia 2013;68(4):422–3.
Gunka V, Soltani P, Astrakianakis G, Martinez M, Albert A, Taylor J, et al. Determination of Chlora Prep® drying time before neuraxial anesthesia in elective cesarean delivery. A prospective observational study. Int J Obstet Anesth 2019;38:19–24.
Malhotra S, Dharmadasa A, Yentis SM. One vs two applications of chlorhexidine/ethanol for disinfecting the skin: implications for regional anaesthesia. Anaesthesia 2011;66(7):574–8.
Stanley D. Are current skin antisepsis guidelines too superficial? Anaesthesia 2015;70(5):634.
Evans L, Cunningham M, Tilakaratna P. Chlorhexidine droplet splash from a skin preparation gallipot: effect of height of pouring. Anaesthesia 2013;68(12):1243–6.
Paternoster M, Niola M, Graziano V. Avoiding Chlorhexidine Burns in Preterm Infants. J Obstet Gynecol Neonatal Nurs 2017;46(2):267–71.
Becton, Dickinson and Company (BD). 2020. ChloraPrep™ in-service resources. [Internet]. [cited 2023 June]. Available from: https://www.bd.com/en-us/offerings/capabilities/infection-prevention/skin-preparation/chloraprep-patient-preoperative-skin-preparation-products/chloraprep-in-service-resources
Avrio Health LP. Betadine solution. [Internet]. 2019 [cited 2023 Jun]. Available form: https://betadine.com/medical-professionals/betadine-solution/
Yang JH, Lim H, Yoon JR, Jeong HI. Tourniquet associated chemical burn. Indian J Orthop 2012;46(3):356–9.
Chiang YC, Lin TS, Yeh MC. Povidone-iodine-related burn under the tourniquet of a child--a case report and literature review. J Plast Reconstr Aesthet Surg 2011;64(3):412–5.
Sivathasan N, Ramamurthy NK, Pabla RS. Chemical burns associated with chlorhexidine-alcohol solution: an avoidable complication? J Burn Care Res 2010;31(5):833.
Ecoffey C, Bosenberg A, Lonnqvist PA, Suresh S, Delbos A, Ivani G. Practice advisory on the prevention and management of complications of pediatric regional anesthesia. J Clin Anesth 2022;79:110725.
Siddiqui NT, Davies S, McGeer A, Carvalho JC, Friedman Z. The effect of gowning on labor epidural catheter colonization rate: a randomized controlled trial. Reg Anesth Pain Med 2014;39(6):520–4.
Vozzola E, Overcash M, Griffing E. An Environmental Analysis of Reusable and Disposable Surgical Gowns. AORN J 2020;111(3):315–25.
Published
Issue
Section
License
Copyright (c) 2024 Abdullah Nisar, Azhar Rehman, Ali Sarfraz Siddiqui
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
