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Spray or swab before epidurals?
- Gabor Debreceni (5 February 2007)
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Spray or Swab?
- Thillaiampalam Kathirgamanathan (22 January 2007)
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Gabor Debreceni
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I have read with interest Dr Kathirgamanathan`s E-letter relating to our recently published article. We never noticed during our study that by using spray technique with a dye containing alcoholic solution we could miss any areas surrounding the planned puncture site. If plenty of amount of disinfectant is sprayed thoroughly, this danger is not real. Training the theatre staff to perform this type of disinfection could prevent any technical failure. For alcoholic solutions to get the maximum effect one has to wait for complete drying. So it is not a disadvantage if at the time of insertion the whole area is dry. We represented in our article in table 3 that the colonization rate and the number of colony formation units at the tip of the catheters were higher in the swab group however it did not reach statistical significance. We do not know the exact connection between disinfection, epidural colonization and infection (1). Theoretically when we use swab we can roll out more bacteria to the skin surface and this phenomenon could be the explanation of the higher colonization rate of the catheters in the swab group but this finding obviously needs more examination. Based on this results we do not think that swab technique is safer to prevent epidural infection. Reference 1 Kostopanagiotov et al Epidural catheter colonizaton is not associated with infection.Surg Infect (Larchmt) 2002 Winter ; 3(4):359-65 Conflict of Interest:None declared |
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Thillaiampalam Kathirgamanathan, Consultant Anaesthetist Watford General Hospital
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I read with interest the study by Debreceni and colleaques comparing the efficacy of conventional swab disinfection with spray disinfection prior to epidural catheterisation. In our hospital we use pink chlorhexdine Gluconate 0.5% w/v in 70% v/vDEB for spray technique and Chlorhexidine 0.5 % w/v in 70% v/v DEB for swab tecnique.According to this study, spray disinfection is at least as effective as swab disinfection for 2 Propanol and benzalkonium chloride solution. I would like to highlight few important practical variations in the day to day practice. The area to be disinfected is clearly identified with the swab tecnique with the Chlorhexidine red staining solution. Further it is applied by the operator before the procedure. With the spray technique it is difficult to spot the missing areas. Also It is usually applied by the operating department practitioners. Sometimes the the site is sprayed and dried even before the operator is scrubbed and ready for the procedure.This would not happen with the swab tecnique. Serious infection like bacterial menningitis and epidural abscess are rare. But if they do happen it could have serious consequences. Further the incidence of infective complication have increased. Aromaa et al(1) reporetd an overall frequency of 1.1 per 100,000blocks. More recent study by Wang and colleaques(2) reported 1 in 1,930.There are various reasons for these enormous discrepency(3). Therefore it is important to take every step to prevent the infective complication. Hence I would recommend to use swab technique. references 1. Aromaa U Lahdensuu M Cozanitis DA Severe complications associated with epidural and spinal anaesthesia in Finland 1987- 1993 A study based on patient insurance claims Acta Anaesthesiol Scand 1997: 41:445-452 2. Wang LP hauerberg J Schmidt JF incidence of spinal epidural abscess after epidural analgesia: A national 1 year survey Anaesthesiology 1999;91: 1928-1936 3.James R Hebl, MD The importance and implications of Aseptic techniques during regional Anaesthesia Regional Anaesthesia and pain medicine vol 31, no 4 2006 pp 311-323 Conflict of Interest:None declared |
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