Sterility of epidural solutions - Recommendations for cost- effective use

Background and Objectives: Specific recommendations or guidelines for duration of use or 'hangtime' for epidural solutions have not been established. Presently, most hospital policies limit expiration dating of these solutions to 24 hours at room temperature. Extending expiration dating would reduce or eliminate the manipulation of the epidural system during the course of therapy. The objective of this study was to assess the bacteriologic status over time of pharmacy-prepared epidural solutions to determine if longer expiration dating could be safely instituted. Methods: Samples from both previously administered and nonadministered bags of epidural infusate solutions were retrieved for bacteriologic testing and maintained at room temperature. These solutions were tested every 5 to 7 days beginning 24 to 48 hours after preparation. Results: Samples of 54 infusion bags were tested for a median duration of 63 days. One hundred fifteen samples were tested. Only 5 samples of 4 solutions reported positive cultures; no growth was reported for multiple subsequent cultures of these solutions. Conclusions: Samples of pharmacy-prepared epidural solutions remained sterile for greater than 42 days. A change from epidural solution expiration dating of 24 hours to 48 or 72 hours would translate into a cost savings of $36,375 to $48,450 at our institution.