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Philips T, Molenaers B, Caekebeke P, Flies M, Vanderhaeghen O, Duerinckx J. Comparison of time-efficiency of individually wrapped screws and sterile screw racks in distal radius fracture treatment. Arch Orthop Trauma Surg 2024; 144:2127-2129. [PMID: 38494566 DOI: 10.1007/s00402-024-05278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Time-efficiency of individually wrapped screws versus screws in a screw rack is not well established. MATERIALS AND METHODS We performed a prospective single-center clinical study timing the interval between the surgeon asking and receiving a screw during plate and screw osteosynthesis of distal radius fractures. Patients were randomized for individually wrapped screws or screws in a screw rack. The study was conducted in a Level 1 Trauma Center and surgeries were performed between March and June 2023. RESULTS Average handling time for screws from a screw rack was 9 s (SD 5.5; range 3-28) and 22 s for individually wrapped screws (SD 6.1; range 6-38). This average difference of 13 s is significant (p < 0.0001). CONCLUSION There is a significant increase in handling time using individually wrapped screws over using a screw rack. LEVEL OF EVIDENCE Level I (therapeutic, randomized controlled trial).
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Affiliation(s)
- Tim Philips
- Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium
- Department of Orthopaedic Surgery and Traumatology, University Hospital Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Ben Molenaers
- Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium
| | - Pieter Caekebeke
- Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium
| | - Mike Flies
- DEO.Care, Paalsesteenweg 170, 3583, Beringen, Belgium
| | | | - Joris Duerinckx
- Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium.
- Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan 5, 3590, Diepenbeek, Belgium.
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Suchowersky AM, Hua M, Lorentzos P, Ashton LA. A comparison of risk profile for orthopaedic operations when utilizing individually wrapped screws (IWS) when compared with sterile screw caddies (screw racks). J Orthop Surg (Hong Kong) 2021; 28:2309499020944086. [PMID: 32830601 DOI: 10.1177/2309499020944086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There has been a global trend towards individually packaged screws for orthopaedic operations. Traditional practice makes use of screw caddies that require re-sterilization. Individually wrapped screws (IWS) are purported to decrease infection rates and avoid the deleterious effects of repeated screw sterilizations, despite marginal evidence. This review aimed to evaluate the safety, effectiveness and economics of screw caddies with IWS. MATERIAL AND METHODS The literature was surveyed in a systematic fashion between 1998 and 2017 and all relevant health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, cohort studies, case-controlled studies and case series were sought. Any benefits or otherwise of IWS over screw caddies were then evaluated in the areas of safety, effectiveness and economics. RESULTS Two level III-3 papers suggested the use of caddies at least as safe as individual screws. Four level III-2 papers demonstrated that screws from caddies were as effective as individual alternatives, while a level III-3 paper reported that individual screws were significantly more expensive than screw caddies. Cost increases to our regional health service from ankle open reduction and internal fixations alone of at least $50,112 (AUD) per annum were calculated. CONCLUSIONS From the results obtained, the authors recommend the continued use of screw caddies for orthopaedic procedures.
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Affiliation(s)
| | - Martin Hua
- Bathurst and Orange Orthopaedic Surgeons Association, Orange, NSW, Australia.,Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | - Peter Lorentzos
- Bathurst and Orange Orthopaedic Surgeons Association, Orange, NSW, Australia
| | - L Andrew Ashton
- Bathurst and Orange Orthopaedic Surgeons Association, Orange, NSW, Australia
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Schömig F, Perka C, Pumberger M, Ascherl R. Implant contamination as a cause of surgical site infection in spinal surgery: are single-use implants a reasonable solution? - a systematic review. BMC Musculoskelet Disord 2020; 21:634. [PMID: 32977778 PMCID: PMC7519515 DOI: 10.1186/s12891-020-03653-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023] Open
Abstract
Background In spine surgery, surgical site infection (SSI) is one of the main perioperative complications and is associated with a higher patient morbidity and longer patient hospitalization. Most factors associated with SSI are connected with asepsis during the surgical procedure and thus with contamination of implants and instruments used which can be caused by pre- and intraoperative factors. In this systematic review we evaluate the current literature on these causes and discuss possible solutions to avoid implant and instrument contamination. Methods A systematic literature search of PubMed addressing implant, instrument and tray contamination in orthopaedic and spinal surgery from 2001 to 2019 was conducted following the PRISMA guidelines. All studies regarding implant and instrument contamination in orthopaedic surgery published in English language were included. Results Thirty-five studies were eligible for inclusion and were divided into pre- and intraoperative causes for implant and instrument contamination. Multiple studies showed that reprocessing of medical devices for surgery may be insufficient and lead to surgical site contamination. Regarding intraoperative causes, contamination of gloves and gowns as well as contamination via air are the most striking factors contributing to microbial contamination. Conclusions Our systematic literature review shows that multiple factors can lead to instrument or implant contamination. Intraoperative causes of contamination can be avoided by implementing behavior such as changing gloves right before handling an implant and reducing the instruments’ intraoperative exposure to air. In avoidance of preoperative contamination, there still is a lack of convincing evidence for the use of single-use implants in orthopaedic surgery.
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Affiliation(s)
- Friederike Schömig
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Rudolf Ascherl
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Vocelle AR, Trier T, Bix L, Bush TR. A method for quantifying key components of the opening process for opening pouch-style packages containing medical devices. APPLIED ERGONOMICS 2019; 76:97-104. [PMID: 30642530 DOI: 10.1016/j.apergo.2018.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 12/09/2018] [Accepted: 12/13/2018] [Indexed: 06/09/2023]
Abstract
Healthcare-associated infections are a serious worldwide health concern. Although contaminated medical devices are an avenue for infection, little research has evaluated the techniques used to open sterile packages. The goal of this study was to develop a method to quantify aspects of the package opening process in accordance with opening guidelines and then to demonstrate this methodology through a small sample of clinicians opening two sizes of pouch-style packages. Using motion capture techniques, a method was designed to quantify 11 parameters associated with the opening process. The method was then tested with nine healthcare professionals. Results indicated that all participants crossed the sterile field when opening packages. When opening large packages, participants spent significantly more time over the simulated sterile field and there was a trend towards more manipulations as compared to opening smaller packages. This methodology can be used to quantify the opening process, compare opening practices, and for assessment during the learning process.
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Affiliation(s)
- Amber R Vocelle
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Tony Trier
- School of Packaging, Michigan State University, East Lansing, MI, USA
| | - Laura Bix
- School of Packaging, Michigan State University, East Lansing, MI, USA
| | - Tamara Reid Bush
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA; Department of Biomedical Engineering, Michigan State University, East Lansing, MI, USA.
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Perez P, Bush TR, Hong HG, Pan W, Miller L, Bix L. Reducing levels of medical device contamination through package redesign and opening technique. PLoS One 2018; 13:e0206892. [PMID: 30403724 PMCID: PMC6221329 DOI: 10.1371/journal.pone.0206892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/22/2018] [Indexed: 01/08/2023] Open
Abstract
Objectives The goal of this research was to evaluate how material curl, package structure and handling of pouches containing medical devices affect rates of contact between non-sterile surfaces and sterile devices during aseptic transfer. Methods One hundred and thirty-six individuals with practical experience in aseptic technique were recruited. Participants were asked to present the contents of four different pouch designs (a standard, one designed to curl in, another to curl out and one that incorporated a tab) using two transfer techniques. During the first block of trials “standard technique” was used; participants presented using their typical methods to the sterile field. Trials in the second block employed “modified technique”; participants were instructed to grab the package at the top center and present package contents using a single, fluid motion. The outside of the pouch and the backs of the participants’ hands were coated using a simulated contaminant before each trial. The simulant was undetectable in the visible spectrum, but fluoresced under a black light. The dependent variable was recorded in a binary fashion and analyzed using a generalized linear mixed model. Results Participants were between 20–57 and the averaged year 5.1 years of experience in aseptic technique. The data analysis was based on generalized linear mixed effects (GLMM) model, which accommodates the repeated measurements within the same participant. The effect of the pouch design was significant (P‹0.001), but the effect of aseptic technique did not suggest significance (P = 0.088). Specifically, pouches designed with the material curled outward resulted in significantly fewer contacts with non-sterile surfaces than the other styles, including the inward, tab, and standard styles; this was true regardless of the used aseptic technique, standard (P = 0.0171, P = 0.0466, P = 0.0061, respectively) or modified (P‹0.0001 for all comparisons)). Conclusion Results presented here contribute to a growing body of knowledge that investigates packaging as a potential route of contamination for sterile devices during aseptic presentation. Specifically, we provide insights regarding how both package design and opening technique can be informed in ways that build safety into the healthcare system.
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Affiliation(s)
- Paula Perez
- School of Packaging, Michigan State University, East Lansing, MI, United States of America
| | - Tamara Reid Bush
- Mechanical Engineering Dept., Michigan State University, East Lansing, MI, United States of America
| | - Hyokyoung G. Hong
- Department of Statistics and Probability, Michigan State University, East Lansing, MI, United States of America
| | - Wu Pan
- Mechanical Engineering Dept., Michigan State University, East Lansing, MI, United States of America
| | - Larissa Miller
- Advanced Chronic Nursing Care, Nursing Program, Lansing Community College, Lansing, MI, United States of America
| | - Laura Bix
- School of Packaging, Michigan State University, East Lansing, MI, United States of America
- * E-mail:
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Trier T, Bello N, Bush TR, Bix L. The role of packaging size on contamination rates during simulated presentation to a sterile field. PLoS One 2014; 9:e100414. [PMID: 25003738 PMCID: PMC4086713 DOI: 10.1371/journal.pone.0100414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 05/27/2014] [Indexed: 11/18/2022] Open
Abstract
Objective The objective of this study was to assess the impact of package size on the contact between medical devices and non-sterile surfaces (i.e. the hands of the practitioner and the outside of the package) during aseptic presentation to a simulated sterile field. Rationale for this objective stems from the decades-long problem of hospital-acquired infections. This work approaches the problem from a unique perspective, namely packaging size. Design Randomized complete block design with subsampling. Setting Research study conducted at professional conferences for surgical technologists and nursing professionals. Participants Ninety-seven healthcare providers, primarily surgical technologists and nurses. Methods Participants were gloved and asked to present the contents of six pouches of three different sizes to a simulated sterile field. The exterior of pouches and gloves of participants were coated with a simulated contaminant prior to each opening trial. After presentation to the simulated sterile field, the presence of the contaminant on package contents was recorded as indicative of contact with non-sterile surfaces and analyzed in a binary fashion using a generalized linear mixed model. Results Recruited subjects were 26–64 years of age (81 females, 16 males), with 2.5–44 years of professional experience. Results indicated a significant main effect of pouch size on contact rate of package contents (P = 0.0108), whereby larger pouches induced greater rates of contact than smaller pouches (estimates±SEM: 14.7±2.9% vs. 6.0±1.7%, respectively). Discussion and Conclusion This study utilized novel methodologies which simulate contamination in aseptic presentation. Results of this work indicate that increased contamination rates are associated with larger pouches when compared to smaller pouches. The results add to a growing body of research which investigate packaging's role in serving as a pathway for product contamination during aseptic presentation. Future work should investigate other packaging design factors (e.g. material, rigidity, and closure systems) and their role in contamination.
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Affiliation(s)
- Tony Trier
- School of Packaging, Michigan State University, East Lansing, Michigan, United States of America
| | - Nora Bello
- Department of Statistics, Kansas State University, Manhattan, Kansas, United States of America
| | - Tamara Reid Bush
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan, United States of America
| | - Laura Bix
- School of Packaging, Michigan State University, East Lansing, Michigan, United States of America
- * E-mail:
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The economic impact of individually packaged screws. Surgeon 2013; 12:35-9. [PMID: 24012437 DOI: 10.1016/j.surge.2013.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/15/2013] [Accepted: 08/10/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Trends in orthopaedic surgery have seen a migration towards using individually packaged screws (IPS). The manufacturers claim IPS improves sterility, traceability, and avoids the effects of repeated sterilisation. In recent times there has been increasing pressure on the NHS to be more cost-efficient. Challenging decisions must be made to make cost-efficient choices without comprising the quality of care provided. AIM This study investigates the cost-benefit of IPS compared to the conventional screw rack stored screws (SRSS). METHODS A single-centred observational study was carried out in a district general hospital between February and March 2013. One-hundred and forty-seven screws were requested intra-operatively and the screw acquisition time was measured with a digital handheld timer. Screw acquisition time was defined as the time taken from the initial verbal request to when the screw was mounted ready for use. The screws were categorised into two groups: SRSS and IPS. RESULTS The mean screw acquisition time for the SRSS group (n = 94) was 6.6 s (S.D ± 2.5). The mean screw acquisition time for the IPS group (n = 53) was 102.1 s (S.D ± 25.7). The mean difference between SRSS and IPS was 96 s (95%CI 90.3-100.8; p < 0.001). CONCLUSION Our study suggests that the use of IPS significantly (p < 0.001) increases the operation duration and costs compared to SRSS. Based on ankle ORIF procedures alone, the use of IPS could potentially increase department spending by approximately £76,680 per year.
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Khan Y, Tokarczyk S, Khan I, Eleftheriou K, Pearce C. The use of individually wrapped presterilized small orthopaedic implants increase operating time: a prospective experimental study. JRSM SHORT REPORTS 2013; 4:34. [PMID: 23885288 PMCID: PMC3697854 DOI: 10.1177/2042533313476413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective There have been concerns about the potential increases in operating time associated with the use of individually wrapped presterilized small orthopaedic implants compared with our traditional method of screw banks. We set out to quantify this theory. Design Prospective experimental study. Setting Theatre. Participants Orthopaedic Surgical Trainees and Theatre Scrub team. Main outcome measure The time taken to complete the operation. Results The use of prepacked and sterilized implants added 2 min 56 s to the use of a bank with a full complement of normal screws that required tapping and 3 min 58 s if self-tapping screws were used (P < 0.001). Conclusion Using individually wrapped presterilized small orthopaedic implants increases operating time.
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Affiliation(s)
- Yasmeen Khan
- St Mary's Hospital, Imperial College London , Praed Street, Paddington, London W2 1NY
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Peters PG, Laughlin RT, Markert RJ, Nelles DB, Randall KL, Prayson MJ. Timing of C-arm drape contamination. Surg Infect (Larchmt) 2012; 13:110-3. [PMID: 22439783 DOI: 10.1089/sur.2011.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Surgical site infection remains a concern in orthopedic surgery, and contamination of C-arm covers is a potentially modifiable risk factor. METHODS A single-cohort study was conducted using 30 consecutive patients undergoing operative fracture fixation. Cultures were obtained from the C-arm cover after initial draping and every 20 min thereafter. The total number of persons in the operating room (person-hours/h of study time) and the number of door openings were recorded. The C-arm position changes and the time to contamination were monitored. RESULTS The median time from the start of the operation to contamination was 20 min. There was a 17% contamination rate on initial draping, 50% at 20 min, 57% at 40 min, and 80% by 80 min. The C-arms in five cases were not contaminated during the surgery. Time to contamination correlated significantly with lateral position changes (correlation [r]=0.64; p=0.003) but was not related to C-arm position changes (r=0.22; p=0.34), number of door openings (r=0.20; p=0.39), or person-hours/h (r=0.04; p=0.85). CONCLUSIONS Contamination of the C-arm drape occurs often and early during surgery for orthopedic fractures. We recommend minimal contact with the C-arm to avoid contamination of the surgical field.
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Affiliation(s)
- Paul G Peters
- Department of Orthopedics, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
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Thompson S, Townsend R. Pharmacological agents for soft tissue and bone infected with MRSA: which agent and for how long? Injury 2011; 42 Suppl 5:S7-10. [PMID: 22196911 DOI: 10.1016/s0020-1383(11)70126-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infections cause an important number of soft tissue and bone infections, although exact rates vary across different countries and institutions. The length of antibiotic treatment required depends upon the severity of infection and pre-existing co-morbidities. Monitoring response to treatment is important to ensure cure of infection whilst preventing excessive antibiotic use. Debridement and drainage, in addition to prosthesis removal, may be necessary. Numerous antibiotics are effective at treating soft tissue and bone infected with MRSA. Oral antibiotics, such as clindamycin, doxycycline and linezolid, generally offer good bioavailability and tissue penetration. They are separated largely by side effect profile and drug interactions, which should be considered carefully prior to use. There are also several agents only available in the intravenous (IV) form, for example glycopeptides, daptomycin and tigecycline. These are normally reserved for the treatment of severe infections. Whilst tissue penetration is variable within this group, it is the adverse events linked with each antibiotic that are most effective in determining the preferred agent.
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Affiliation(s)
- S Thompson
- Microbiology Department, Northern General Hospital, Sheffield, S5 7AU, UK
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