A national survey of prevention of infection in obstetric central neuraxial blockade in the UK

Abstract

SummaryWe conducted a postal survey of all consultant-led UK obstetric anaesthetic units in August 2009, to assess the standard of aseptic technique used for neuraxial blocks. One hundred and sixty-four units responded giving a response rate of 76%; 93% of units (149 ⁄ 160) follow recommended precautions and attach a bacterial micropore filter to the epidural catheter. Epidural top-ups are provided by 72% (116 ⁄ 162) of units, with about two thirds using premixed solutions (of local anaesthetic with opioid) in a variety of ways: 51% (57 ⁄ 111) via a continuous infusion pump; 47% (52 ⁄ 111) by a prefilled syringe; and 23% (25 ⁄ 111) by multiple use of a premixed bag of solution. For spinals, 91% of units (149 ⁄ 164) add diamorphine: of these 85% (126 ⁄ 149) draw the diamorphine from non-sterile-wrapped ampoules. If required to draw opioid from a nonsterile-wrapped ampoule, 86% (119 ⁄ 138) of units use a micropore filter and 21% (29 ⁄ 138) wipe the ampoule neck with an alcohol swab. Although sepsis secondary to neuraxial block in obstetric practice is uncommon (declared by 8.5% of units over an unspecified period of time), there is scope for further improvement. In January 2009, the Royal College of Anaesthetists published the National Audit Project (NAP) 3 Report [4], with a chapter on complications after neuraxial block in obstetric practice, which included infection. Subsequent learning points and recommendations were stated.The aim of this survey was to ascertain the standard of aseptic practice in the UK, with reference to these national guidelines and recommendations. MethodsData were collected from a questionnaire sent, together with a covering letter, to the lead obstetric anaesthetist in 221 maternity units in the UK. Approval for the survey was obtained from the Obstetric Anaesthetists' Association's Audit Subcommittee, which provided postal details. In the covering letter, each lead obstetric anaesthetist was asked to complete the questionnaire, commenting on the current practice in his or her unit. The questionnaire was designed to assess compliance with the current recommended good practice. The lead clinicians were asked to tick 'yes' or 'no' to questions and provide a few words of comment, where appropriate, with regard to practice in their maternity units. There were five sections of the questionnaire: Anaesthesia, 2011Anaesthesia, , 66, pages 497-502 doi:10.1111Anaesthesia, /j.1365Anaesthesia, -2044Anaesthesia, .2011.06705. x ................................................................................................................................................................................................................ 497facilities and practice in setting up epidural analgesia in the labour suite; management of epidural catheter disconnection; method of administering the epidural drugs, in particular the source of premixed epidural local anaesthetic with opioid and the precautions taken; the precautions taken with administration of spinal opioids; and lastly, an invitation to c...

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