Human Skin Flora as a Potential Source of Epidural Abscess

Abstract

In a large proportion of patients, isolation of viable organisms from excised skin specimens after disinfection with 10% PVP-I suggests that contamination of the epidural space by the skin flora may be a potential mechanism of epidural infection associated with epidural block.

The Importance and Implications of Aseptic Techniques During Regional Anesthesia

“…Finally, Sato and colleagues 14 have also shown that resident bacteria are hidden deep in hair follicles and orifices of sebaceous glands, locations that are often protected from disinfectants by lipids overlying the stratum corneum. Therefore, despite meticulous attention to skin disinfection, microorganisms may still persist under the skin when using antiseptics that are unable to penetrate the stratum corneum.…”

“…Extrinsic sources of infection include invasion of skin bacteria through a needle tract, [14][15][16][17][18] contaminated syringes, 19 catheter hubs, 20 local anesthetics, 21 or breaches in aseptic technique. [21][22][23][24] The migration of skin bacteria through needle puncture sites is considered to be a major source of epidural colonization.…”

“…[21][22][23][24] The migration of skin bacteria through needle puncture sites is considered to be a major source of epidural colonization. 14 Several investigations have shown that organisms persist on the skin surface after preparation with a variety of antiseptic solutions. 4,[25][26][27][28][29] The detection of these organisms lends support to the possibility that the needle may "push" pathogens into the epidural space during catheter placement.…”

“…4,14,[25][26][27][28][29]77,80,81 In all but 1 investigation, 25 chlorhexidine resulted in a more rapid and superior bactericidal effect that extended several hours beyond its initial application. Sakuragi and colleagues 27 performed a comprehensive evaluation of these 2 compounds on 4 strains of methicillin-resistant and 2 strains of methicillinsusceptible S aureus, the pathogen most commonly associated with epidural space infections.…”

Skin Disinfection before Epidural Catheterization: Comparative Study of Povidone-Iodine versus Chlorhexidine Ethanol

“…Catheters kept in place for a short time are generally colonized by skin flora present on the catheter insertion sites during catheter placement [4]. Thus, effective cutaneous antisepsis before epidural insertion may reduce catheter colonization and epidural-catheter-related serious infection.…”