A national survey of prevention of infection in obstetric central neuraxial blockade in the UK

We conducted a postal survey of all consultant-led UK obstetric anaesthetic units in August 2009, to assess the standard of aseptic technique used for neuraxial blocks. One hundred and sixty-four units responded giving a response rate of 76%; 93% of units (149/160) follow recommended precautions and attach a bacterial micropore filter to the epidural catheter. Epidural top-ups are provided by 72% (116/162) of units, with about two thirds using premixed solutions (of local anaesthetic with opioid) in a variety of ways: 51% (57/111) via a continuous infusion pump; 47% (52/111) by a prefilled syringe; and 23% (25/111) by multiple use of a premixed bag of solution. For spinals, 91% of units (149/164) add diamorphine: of these 85% (126/149) draw the diamorphine from non-sterile-wrapped ampoules. If required to draw opioid from a non-sterile-wrapped ampoule, 86% (119/138) of units use a micropore filter and 21% (29/138) wipe the ampoule neck with an alcohol swab. Although sepsis secondary to neuraxial block in obstetric practice is uncommon (declared by 8.5% of units over an unspecified period of time), there is scope for further improvement.