EPIDURAL CATHETERS

PREVENTION OF COLONIZATION

Abstract

Objectives: 1) To determine if an alcoholic solution of 0.5% chlorhexidine
is more effective than an aqueous solution of 10% povidone-iodine in reducing skin colonization associated with epidural
catheter placement. 2) To determine the above two solutions is more effective in reducing epidural catheter tip bacterial
colonization. Design: Randomized observational study. Setting: Department of Anaesthesiology in Combined Military
Hospital, Rawalpindi. Period: April 2001 to September 2001. Material and Methods: One hundred adults who were
planned to receive epidural analgesia using epidural catheter for postoperative pain relief were randomly divided into
two groups, one to receive an aqueous solution of 10% povidone iodine and the other to receive chlorhexidine as
cutaneous antiseptic before catheter insertion. The insertion sites were cultured qualitatively just before epidural
catheter removal. After their removal, the catheter tips were quantitatively cultured. Catheters were classified as
colonized when their tips yielded 1,000 or more colony forming units/ml in cultures. Results: A total of 100 patients were
included in the trial, 96 were evaluable. Overall among 96 catheters 32 catheter insertion sites showed positive
bacteriological cultures, 20 in povidone iodine group and 12 in chlorhexidine group (p value 0.03). Cultures of catheter
tips in the chlorhexidine group were significantly less to yield microorganism on removal (five events) than were catheter
tips in the povidone iodine group (15 events ) p value 0.002. The bacterial species isolated from culture of catheter tips
were coagulase negative staphylococci in 19 cases and Enterococcus faecalis in one case. Six, out of the 20 catheters
tips were considered as colonized, catheter colonization occurred less frequently when chlorhexidine was used for skin
preparation (1 events) than when povidone iodine was used (5 event) p value 0.001. Conclusion: An alcoholic solution
of 0.5% chlorhexidine is more effective than an aqueous solution of 10% povidone-iodine in reducing skin colonization
associated with epidural catheter placement, moreover it is also more effective in reducing epidural catheter tip bacterial
colonization.