A systematic review of effectiveness of disinfectants on skin preparation and dressings in patients receiving epidural analgesia

Abstract

Abstract Background Chlorhexidine and povidone iodine are both disinfectants used in the hospital setting. Chlorhexidine has been proven to be superior prior to the insertion of lines such as central venous catheters [Kinirons B, Mimoz O, Lafendi L, Naas T, Meunier J, Nordmann P. Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a randomized, controlled trial. Anesthesiology 2001;94(2):239–44]. The growing number of epidural insertions warrants a review of the literature to determine if chlorhexidine remains the superior skin disinfectant prior to epidural insertion, as well as being useful when impregnated in epidural dressings. Objectives To summarize what is known regarding the effectiveness of disinfectants on skin preparation and dressings in patients receiving epidural analgesia. Methods A systematic review of nine reports of trials was completed to examine the efficacy of disinfectants in patients with epidural analgesia. These reports included randomized controlled trials and clinical trials. Results Findings indicated that chlorhexidine has been proven to be just as, if not more effective than povidone iodine in reducing microbial colonization of epidural catheters when utilized as a skin disinfectant [Kinirons B, Mimoz O, Lafendi L, Naas T, Meunier J, Nordmann P. Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a randomized, controlled trial. Anesthesiology 2001;94(2):239–44; Sato S, Sakuragi T, Dan K. Human skin flora as a potential source of epidural abscess. Anesthesiology 1996;85(6):1276–82; Sakuragi T, Higa K, Dan K, Okubo M. Skin floras on the human back and disinfection with alcoholic chlorhexidine, povidone iodine, and ethyl alcohol. Pain Clinic 1986/1987;1(3):183–8]. Moreover, when used in impregnated dressings, it may further reduce microbial colonization of epidural catheters [Mann T, Orlikowski C, Gurrin L, Keil, A. The effect of the biopatch, a chlorhexidine impregnated dressing, on bacterial colonization of epidural catheter exit sites. Anaesth Intensive Care 2001;29(6):600–3; Shapiro J, Bond E, Garman K. Use of a chlorhexidine dressing to reduce microbial colonization of epidural catheters. Anesthesiology 1990;73:625–31]. Conclusion Chlorhexidine could be considered the cutaneous antiseptic of choice prior to epidural insertion, although further studies to confirm this are warranted. The additions of chlorhexidine impregnated dressings require further studies to validate its use, although early studies are promising.