Background and Goal of Study:
AAGBI has recently published guidelines for skin antisepsis for central neuraxial blockade (CNB). The aim is to produce a concise document that specifically considered which agent to use for skin antisepsis before CNB and the method of application. We conduct a clinical effectiveness audit to ensure compliance with this guideline.

Materials and Methods:
A proforma was designed according to the recommendations made. It includes the optimum aseptic technique, solution used, method of application, number of application, measures to prevent contamination and awareness of the guideline. It was then distributed to all anaesthetists in the department.

Results and Discussion:
We had a response rate of 79% out of a total of 67 from the department. The distribution of the respondents is shown in Figure 1. Trainees and NCCG achieved 100% compliance for aseptic technique but not consultants as shown in Table 1. The majority (92%) uses 0.5% Chlorhexidine in alcohol which is the recommended solution. Spray bottle is the most common technique (96%) for method of application. Application of the solution once (70%) is also more commonly utilised compared to twice. To prevent contamination, 98% of us ensure the solution is fully dry before touching the skin. However, other ways to prevent contamination are less compliant and only 28% routinely check gloves for contamination as shown in Table 2. Only 72% of the respondents were aware of this latest guideline.

Chlorhexidine in alcohol is a very effective antiseptic. Steps to prevent contamination should be adhered to. These include aseptic technique, allowing the solution to fully dry before touching skin, covering or protecting the CNB equipment and checking gloves for contamination. Single spray application is also effective. Repeated application is unnecessary and might increase risk of neurotoxicity if the antiseptic was not allowed to dry completely. 

Conclusion(s):
This guideline provides clear guidance of solution used and method of application to decrease risk of infection and also risk of neurotoxicity. Hence, all anaesthetists or any practitioners performing CNB should adhere to this guideline.

Audit: skin antisepsis for central neuraxial blockade practice