Optimal hand washing technique to minimize bacterial contamination before neuraxial anesthesia: a randomized control trial. (February 2017)

• Record Type: Journal Article
• Authors: Siddiqui, N.; Friedman, Z.; McGeer, A.; Yousefzadeh, A.; Carvalho, J.C.; Davies, S.
• Is Part Of: International journal of obstetric anesthesia. Volume 29(2017)
• Page Start: 39
• Page End: 44
• Publication Date: 2017-02
• Subjects: Hand washing -- Alcohol gel -- Bacterial colonization; Obstetrics -- Periodicals; Anesthesia -- Periodicals; Anesthésie en obstétrique -- Périodiques; Anesthesia; Obstetrics; Electronic journals; Periodicals; 617.9682
• DOI: 10.1016/j.ijoa.2016.09.006
• Languages: English
• ISSNs: 0959-289X

Abstract

Highlights: Neuraxial anesthesia requires strict aseptic measures. There is a paucity of best hand washing technique specifically for neuraxial procedures. Simple hand hygiene with basic soap and water is not truly effective. Alcohol based antiseptic solutions are superior in reducing the incidence of colonization. Abstract: Introduction: Infectious complications related to neuraxial anesthesia may result in adverse outcomes. There are no best practice guidelines regarding hand-sanitizing measures specifically for these procedures. The objective of this study was to compare the growth of microbial organisms on the operator's forearm between five common techniques of hand washing for labor epidurals. Methods: In this single blind randomized controlled trial, all anesthesiologists performing labor epidurals in a tertiary care hospital were randomized into five study groups: hand washing with alcohol gel only up to elbows (Group A); hand washing with soap up to elbows, sterile towel to dry, followed by alcohol gel (Group B); hand washing with soap up to elbows, non-sterile towel to dry, followed by alcohol gel (Group C); hand washing with soap up to elbows, non-sterile towel to dry (Group D) or hand washing with soap up to elbows, sterile towel to dry (Group E). The number of colonies for each specimen/rate per 100 specimens on one or both arms per group was measured. Results: The incidence of colonization was 2.5, 23.0, 18.5, 114.5, and 53.0 in Groups A, B, C, D and E, respectively. Compared to Group A, the odds ratio of bacterial growth for Group B was 1.52 ( P =0.519), Group C 5.44 ( P =0.003), Group D 13.82 ( P <0.001), and Group E 8.65 ( P <0.001). Conclusion: Alcohol-based antiseptic solutions are superior in terms of reducing the incidence of colonization. The results will enable us to develop guidelines to standardize and improve hand-sanitizing practices among epidural practitioners.