Labor Epidurals and Sterile Technique

Trauma Columnist · Jun 5, 2006

When we do LPs or central line placement, all staff wear masks, gloves and sterile gowns. This is an ER setting.

JessP · Jun 5, 2006

I think a lot do not with epidurals.... some do with spinals. That is sad and I wish we could know for sure how/when the contamination happened.

Jess

Tranman · Jun 5, 2006

Huh? funny...I heard the story from my wife who saw the program aforementioned. She said it was b/c the anesthesia provider was not wearing gloves and that they thought the source of bacteria came from a cell phone? Anyways, I missed the program. but to answer your question, no I do not wear a mask when placing epidurals. The usual sterile technique with sterile gloves.

Gompers, BSN, RN · Jun 5, 2006

There's another thread on the board already about this, and in that post it explains more of the story. The woman had not one but two epidurals. Plus, with the second one, it was found to be disconnected at one point and the doctor just reconnected the tubing. No IV antibiotics were ordered when the break in the system was discovered. It was only upon the woman getting sick that any antibiotics were ordered, and it sounds like she didn't get them in time.

https://allnurses.com/forums/f35/deadly-epidural-161286.html

passgasser · Jun 5, 2006

There was a similar case a few years ago. Mom developed epidural infection and died. Bacteria were cultured from patient and from the nose of the anesthesia provider who had placed the epidural (who did not wear a mask.) Bacteria were an identical DNA match. Don't have a link. However, since reading about this, I wear a mask when I place all epidurals. Seems like a quick and easy way to add another level of protection for my patients.

athomas91 · Jun 6, 2006

i watched the show... the first "epidural" had immediate and extensive effects - per the husband she had no sensation up to her clavicles and was c/o diff breathing... the -ologist d/ce the "epidural cath" and later started another one which wasn't "as effective" - when the -ologist came in to problem shoot - found it was unplugged from the pump tubing and reconnected it...

if you want my honest opinion the first "epidural" was in actuality a spinal ...

and yes - i was trained to wear masks for epidurals for that reason - you never know when you will have that inadvertant spinal tap... and to get such a rampant infection in her brain so quickly...

and ampicillin was orderd by the OBGYN after the patient complained of a h/a and spiked a temp - but never given to the patient - a nursing note was acutally shown (handwritten) - "ampicillin not given" - i believe it was written by the ICU nurse after the patient was transferred for seizures

Tranman · Jun 6, 2006

So my wife Tivo'd the program and I just got done watching it and wanted to post a few afterthoughts and opinions. Seems everything posted so far about the program is in fact presented as such in the program.

should also be noted that the husband reported the the MDA was very busy going from suite to suite, being called away often. He even answers his pager and cell phone during the procedure. Now of course this is all hearsay. The husband also recalls that after the 1st epidural, the MDA did the "pin prick" test and she couldn't feel up to her neck. The husband reports that the MDA didn't seem concern at all. Simply said that he would D/c the epidural, wait a while and restart it. It sounds like he did infact had a wet tap and wasn't interested in telling the patient what had just happened. Also, If he was answering his pager and cell phone during the 1st or 2nd procedure (as reported by the husband), that could definitely be the source of infection. A 2nd source could have been from the disconnected epidural line.

After delivery at around 3pm, her nurse did not check up on her for the next 5 hrs as recounted by the husband. I find this hard to believe but all too possible if they were heavily understaffed. At midnight her Obstetrician was notified. the OB doc did not come in but did order Abx to be given. It was noted by the husband and by the charting that it was never given. It could have possibly saved her life, but who knows.

Of course the hospital maintains that she came in with the infection. Her labs show that her WBC and temp were normal upon admission. She was not having any symptoms of any illness prior to and on admission that day.

Hospitals new policy is that everyone in the room during placement of an epidural is required to wear a mask. The program did not mention what became of the anesthesiologist.

Wearing a mask will not decrease the risks of infection if he is breaking sterile technique by answering a pager during the procedure.

This is a sad case. It seems as though there were many things that went wrong that day. Busy MDA, wet tap, questionable unsterile technique, understaffed, lack of monitoring on the OB unit. Lack of communication b/t MDA and patient, MDA and OB nurse. RN maybe didn't check up on the patient after delivery, RN possibly didn't give the ABX that was ordered. Possible MDA abadonement of patient. He knowingly wet taps a patient, doesn't explain it to the family, and fails to check up on her later for any complaints or signs & symptoms of a potential for high spinal during an epidural after wet tap.

All these points could be off and totally not be the case. This is just some thoughts after watching the episode. Keep in mind that sometimes these shows can present the information in a such a way to push a certain opinion/agenda on the viewing public. It does seem as though it is pretty clear cut what happened. It bothers me that the hospital refuses to take responsibility and possibly even be protecting that MDA and themselves by maintaining that she came into the hospital with the infection. Even if she did, it still doesn't discount or answer any of the other numerous issues that possibly lead to her death.

beckinben, CNM · Jun 7, 2006

Hence my question....Do you guys wear a mask when placing your labor epidurals. I will start by stating that I do not.
Underdog

Midwife, not CRNA, but I've been following this story with interest, for obvious reasons. In my hospital, anesthesia always wear masks and hats. Everyone in the room does. Might be overkill, but maybe not.

Becki

Newbie Nurse SMP · Jun 7, 2006

This story just makes me so sad! The poor family! I can't imagine going through something so traumatic! And this scares me a whole lot...I don't have children yet, but my hubby and I wants like 10 lol...not that many for real but you get the picture. As the patient, can you tell your anestigiologist (sry terrible spelling) to suit up completely before doing your epidural? I always have phobias that if I upset or insult someone that it will come back to get me...(That is why I never send food back to the kitchen when I am at a restaurant!). Also, do you get to meet your doctor before he/she does the epidural, or do they just come in and go right to work on you?