title: A national survey of prevention of infection in obstetric central neuraxial blockade in the UK.
abstract: We 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 non-sterile-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.
authors.affiliation: Simpson Centre for Reproductive Health, Royal Infirmary, Edinburgh, UK. alistair.mckenzie@luht.scot.nhs.uk
authors.forename: A G
authors.initials: AG
authors.lastname: McKenzie
authors.forename: K
authors.initials: K
authors.lastname: Darragh
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods / Q000592:standards; D016362:Analgesia, Obstetrical / Q000009:adverse effects* / Q000379:methods / Q000592:standards; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods / Q000592:standards; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods / Q000592:standards; D000779:Anesthetics, Local / Q000008:administration & dosage; D001207:Asepsis / Q000379:methods / Q000592:standards*; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D004340:Drug Contamination / Q000517:prevention & control; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008851:Micropore Filters / Q000706:statistics & numerical data; D011247:Pregnancy; D011364:Professional Practice / Q000592:standards; D011481:Protective Clothing / Q000706:statistics & numerical data; D006113:United Kingdom
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local