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


CONCLUSIONS
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.
Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. Electronic address: naveed.siddiqui@uhn.ca.
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Siddiqui
Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
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Friedman
Department of Microbiology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
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McGeer
Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
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Yousefzadeh
Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
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Carvalho
Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
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Davies
D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000072080:Anesthesiologists / Q000706:statistics & numerical data; D000891:Anti-Infective Agents, Local; D058491:Bacterial Load / Q000187:drug effects*; D003428:Cross Infection / Q000517:prevention & control*; D000431:Ethanol; D005260:Female; D005542:Forearm / Q000382:microbiology; D005782:Gels; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D008297:Male; D011247:Pregnancy; D016037:Single-Blind Method; D012915:Soaps
D000891:Anti-Infective Agents, Local; D005782:Gels; D012915:Soaps; D000431:Ethanol
Alcohol gel; Bacterial colonization; Hand washing