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01.12.2014 | Original research article | Ausgabe 1/2014 Open Access

Israel Journal of Health Policy Research 1/2014

Performance of aseptic technique during neuraxial analgesia for labor before and after the publication of international guidelines on aseptic technique

Israel Journal of Health Policy Research > Ausgabe 1/2014
Alex Ioscovich, Elyad M Davidson, Sharon Orbach-Zinger, Zvia Rudich, Simon Ivry, Laura J Rosen, Alexander Avidan, Yehuda Ginosar
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​2045-4015-3-9) contains supplementary material, which is available to authorized users.
Alex Ioscovich, Elyad M Davidson contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

AI designed the study, wrote the questionairre,supervised data collection in the different hospitals and helped write the manuscript. EMD provided valuable clinical insights, helped design the questionairre and helped write the manuscript. SOZ helped supervise data collection. ZR helped supervise data collection. SI helped supervise data collection. LJR performed the statistical analysis. AA designed the questionairre and analyzed the questionairre data. YG designed the study, wrote the questionairre, helped supervise data collection and wrote the manuscript. All authors read and approved the final manuscript.



Aseptic technique and handwashing have been shown to be important factors in perioperative bacterial transmission, however compliance often remains low despite guidelines and educational programs. Infectious complications of neuraxial (epidural and spinal) anesthesia are severe but fortunately rare. We conducted a survey to assess aseptic technique practices for neuraxial anesthesia in Israel before and after publication of international guidelines (which focused on handwashing, jewelry/watch removal and the wearing of a mask and cap).


The sampling frame was the general anesthesiology workforce in hospitals selected from each of the four medical faculties in Israel. Data was collected anonymously over one week in each hospital in two periods: April 2006 and September 2009. Most anesthesiologists received the questionnaires at departmental staff meetings and filled them out during these meetings; additionally, a local investigator approached anesthesiologists not present at these staff meetings individually. Primary endpoint questions were: handwashing, removal of wristwatch/jewelry, wearing mask, wearing hat/cap, wearing sterile gown; answering options were: "always", "usually", "rarely" or "never". Primary endpoint for analysis: respondents who both always wash their hands and always wear a mask ("handwash-mask composite") - "always" versus "any other response". We used logistic regression to perform the analysis. Time (2006, 2009) and hospital were included in the analysis as fixed effects.


135/160 (in 2006) and 127/164 (in 2009) anesthesiologists responded to the surveys; response rate 84% and 77% respectively. Respondents constituted 23% of the national anesthesiologist workforce. The main outcome "handwash-mask composite" was significantly increased after guideline publication (33% vs 58%; p = 0.0003). In addition, significant increases were seen for handwashing (37% vs 63%; p = 0.0004), wearing of mask (61% vs 78%; p < 0.0001), hat/cap (53% vs 76%; p = 0.0011) and wearing sterile gown (32% vs 51%; p < 0.0001). An apparent improvement in aseptic technique from 2006 to 2009 is noted across all hospitals and all physician groups.


Self-reported aseptic technique by Israeli anesthesiologists improved in the survey conducted after the publication of international guidelines. Although the before-after study design cannot prove a cause-effect relationship, it does show an association between the publication of international guidelines and significant improvement in self-reported aseptic technique.
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