Skin disinfection and epidural insertion

[Lesley Lewis]

Can someone please direct me to any documentation guiding the most appropriate strength of chlorhexidine for skin disinfection prior to epidural insertion.
I am reviewing a request to use 0.5% chlorhexidene in 70% alcohol to minimise any risk from residual chlorhexidene being transmitted on the needle to the meninges. While there is information available for prevention of catheter related bloodstream infections my lit search has not found anything specifying the ideal strength for epidural insertion.

thanks Lesley Lewis
Regional Infection Control Consultant
Hume Region Infection Control Resosurce and Consulting Service

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[Fiona de Sousa]

Hi Lesley,

Our facility has used a 1% CHG in 75% ethanol skin prep for epidurals
for quite a number of years without incident. However we reviewed this
earlier this year following an article in the journal Anaesthesia News
titled ‘The Truth, The Whole Truth” (available at the following
website):
http://www.aagbi.org/publications/anaesthesia_news/2010/feb2010.pdf

We were not able to find any guidelines clearly specifying the strength
for epidural skin prep. However an e-letter discussion sparked by the
following article was helpful.

T. M. Cook, D. Counsell, and J. A. W. Wildsmith Major complications of
central neuraxial block: report on the Third National Audit Project of
the Royal College of Anaesthetists Br. J. Anaesth. (2009) 102(2):
179-190 first published online January 12, 2009 doi:10.1093/bja/aen360

After a lengthy investigation and multidisciplinary review it was agreed
to continue using the current skin prep. I am happy to discuss this
offline if you want further information.

Regards,

Fiona De Sousa

Infection Prevention & Control Coordinator, SAH

02 9487 9732

—–Original Message—–
Behalf Of Lesley Lewis
insertion

Can someone please direct me to any documentation guiding the most
appropriate strength of chlorhexidine for skin disinfection prior to
epidural insertion.

I am reviewing a request to use 0.5% chlorhexidene in 70% alcohol to
minimise any risk from residual chlorhexidene being transmitted on the
needle to the meninges. While there is information available for
prevention of catheter related bloodstream infections my lit search has
not found anything specifying the ideal strength for epidural insertion.

thanks Lesley Lewis

Regional Infection Control Consultant

Hume Region Infection Control Resosurce and Consulting Service

Messages posted to this list are solely the opinion of the authors, and
do not represent the opinion of AICA.

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