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The Effect of Gowning on Labor Epidural Catheter Colonization Rate: A Randomized Controlled Trial
  1. Naveed T. Siddiqui, MD, MSc*,,
  2. Sharon Davies, MD, BSc, FRCPC*,,
  3. Allison McGeer, MD, FRCPC,§,
  4. Jose C. A. Carvalho, MD, PhD, FANZCA, FRCPC*, and
  5. Zeev Friedman, MD*,
  1. *Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada
  2. University of Toronto, Toronto, Ontario, Canada
  3. Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
  4. §Departments of Laboratory Medicine and Pathobiology and Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
  1. Address correspondence to: Naveed T. Siddiqui, Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Room 19-104, 600 University Ave, Toronto, Ontario, Canada M5G1X5 (e-mail: naveed.siddiqui{at}uhn.ca).

Abstract

Background The need to gown for labor epidural catheter insertion is controversial. The American Society of Regional Anesthesia and Pain Medicine has identified a lack of randomized controlled trials investigating this issue. The purpose of this study was to examine the effect of gowning on colonization rates following epidural catheter insertion for labor analgesia.

Methods Following research ethics board approval and informed written consent, parturients were randomized to undergo epidural analgesia with the anesthesiologist either ungowned or wearing a sterile gown. Cultures were obtained from each of the operator forearms, the work area under the insertion site, and from the epidural catheter tip as well as from the catheter segment adjacent to the insertion site. The primary outcome was growth of any microbial organisms from the cultured sites.

Results Two hundred fourteen patients completed the study. There were no significant differences in catheter-tip colonization rates between the ungowned and gowned groups (9.2% vs 7.6%, respectively). The most common microorganism that was cultured was coagulase-negative Staphylococcus.

Conclusions The use of gowns in the current study did not affect catheter colonization rate. Overall, there was a relatively high incidence of catheter-tip colonization in both groups, which underscores the need for strict aseptic technique.

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Footnotes

  • Attribution: The work should be attributed to the Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto.

    This work was funded by an Ontario Ministry of Health and Long-term Care Innovation Fund.

    This study was presented in part at the 43rd Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, Henderson, Nevada, April 2011, and at the Canadian Anesthesiologists’ Society Annual Meeting, Toronto, Ontario, Canada, June 2011.

    The authors declare no conflict of interest.

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