Obstetric epidural catheter-related infections at a major teaching hospital: a retrospective case series

The Effect of Gowning on Labor Epidural Catheter Colonization Rate

“…Rates of 0.8% to 6% of overt infections of the skin at the epidural insertion site have been reported after a few days of catheterization. 18 This observation is consistent with the fact that when epidural catheters are kept in for a longer duration the risk of deep tissue infection is increased. 19,20 Coagulase-negative Staphylococcus, a part of normal skin flora, was the most common microorganism found in our study.…”

Neuraxial Anesthesia and the Use of Sterile Gowning

“…Patients undergoing neuraxial anesthesia are at risk for infections that can lead to complications such as arachnoiditis, epidural abscess, meningitis, sepsis, cardiac arrest, or death 1‐7 . Infectious complications are known to cause serious and devastating morbidity and mortality; however, until recently, anesthesia professionals believed these complications to be rare in patients receiving neuraxial anesthesia 1‐7 . In the past 10 years, new studies have shown a higher incidence of infectious complications associated with neuraxial anesthesia than were previously reported 8,9 …”

“…Sources of contamination include poor aseptic technique and bacterial migration along an epidural catheter track to deeper tissues 10,11 . Other sources of infection include contaminated prep or local solutions, disconnection and subsequent contamination of epidural catheters and catheter caps, and contamination from a patient's own microbial flora resulting from substandard use of antiseptic prep solutions 4 . Despite the increased experience and skill levels of anesthesia professionals who perform epidural anesthesia, Friedman et al 11 found a nonsignificant correlation between infection and the practitioner's aseptic technique.…”

“…Despite the increased experience and skill levels of anesthesia professionals who perform epidural anesthesia, Friedman et al 11 found a nonsignificant correlation between infection and the practitioner's aseptic technique. The standards of aseptic technique, particularly with respect to gowning while performing regional anesthesia, seem to be related to local practice standards 4,10,11 …”

“…Green and Paech 4 retrospectively studied epidural catheter‐related infections in obstetric patients using the International Statistical Classification of Diseases coding to identify complications from spinal or epidural anesthesia. They reported that of the 9,482 obstetrical patients receiving epidural analgesia, 258 developed complications 4 . Forty‐nine of these patients developed epidural‐related infections, four of which involved either an epidural or paraspinal abscess.…”