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Abstract
Containment of unopened sterile supplies during procedures Key words: unopened sterile instruments, unopened sterile supplies, contamination, containment, event-related sterility. Contamination of solutions in sterile basins Key words: sterile basin, splash basin, instrument table, solution contamination, surgical site infection. Preventing contamination of solutions in sterile basins Key words: sterile basin, splash basin, instrument table, solution contamination, airborne particulates. Surgical mask selection Key words: surgical mask, product label, facial fit, barrier level.
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Fuchs M, Pumberger M, Hommel H, Perka C, von Roth P, Thiele K. Bacterial Colonization of Irrigation Fluid during Aseptic Revision Knee Arthroplasty. J Clin Med 2020; 9:jcm9092746. [PMID: 32854365 PMCID: PMC7565972 DOI: 10.3390/jcm9092746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 11/25/2022] Open
Abstract
Surgical risk factors for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) are the subjects of ongoing research. It is unclear if there are specific locations of the surgical area that might act as a pathogen source. Due to the fact that bacterial replication occurs preferably under humid conditions, it was our aim to investigate if irrigation fluid reservoirs on the surgical covers are subject to bacterial colonization. We prospectively observed 40 patients with scheduled aseptic 1-stage TKA revision. At time intervals of 30 min, irrigation samples were tested for microbiological colonization. Additionally, the suction tip was investigated at the end of surgery. Overall, a bacterial detection rate of 25% was found (57/232 samples). Analysis for any positive microbial detection revealed pathogen findings of irrigation fluid in 41.7% of samples after 30 min with a constant increase up to 77.8% after 90 min. Twenty-three percent of suction tips showed bacterial colonization. Coagulase-negative staphylococci, accounting for the majority of PJI, were the predominant pathogens. After an average follow-up of 17 months, no PJI was confirmed. Despite the substantial bacterial load of irrigation fluid, PJI rates were not elevated. Nevertheless, we recommend that irrigation fluid reservoirs should be prevented and not withdrawn by suction.
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Affiliation(s)
- Michael Fuchs
- RKU University Department of Orthopaedics, University of Ulm, 89081 Ulm, Germany
- Correspondence:
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, University Department of Orthopaedics, Charité–University Medicine, 10117 Berlin, Germany; (M.P.); (C.P.); (K.T.)
| | - Hagen Hommel
- Department of Orthopaedics, Märkisch-Oderland Hospital, 16269 Wriezen, Germany;
| | - Carsten Perka
- Center for Musculoskeletal Surgery, University Department of Orthopaedics, Charité–University Medicine, 10117 Berlin, Germany; (M.P.); (C.P.); (K.T.)
| | - Philipp von Roth
- Sporthopaedicum Regensburg and Straubing, 93053 Regensburg, Germany;
| | - Kathi Thiele
- Center for Musculoskeletal Surgery, University Department of Orthopaedics, Charité–University Medicine, 10117 Berlin, Germany; (M.P.); (C.P.); (K.T.)
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Ploeger MM, Jacobs C, Gathen M, Kaup E, Randau TM, Friedrich MJ, Hischebeth GT, Wimmer MD. Fluid collection bags pose a threat for bacterial contamination in primary total hip arthroplasty: a prospective, internally controlled, non-blinded trial. Arch Orthop Trauma Surg 2018; 138:1159-1163. [PMID: 29948224 DOI: 10.1007/s00402-018-2970-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Surgical equipment, and especially the so-called 'splash basins' that are used intraoperatively, are a potential source of bacterial contamination in primary total hip arthroplasty (THA). With this risk in mind, many commercially available draping kits include plastic bags that can be used to collect fluid or to temporarily store instruments. Following this rationale, we hypothesised that first: the fluid collection bags are a potential reservoir of bacteria and second: there is a time dependency for bacterial contamination. MATERIALS AND METHODS After ethics approval, we investigated in a prospective, internally controlled, non-blinded trial 43 patients who received primary THA. At the beginning of the surgery, we took deep, representative, intracapsular tissue samples, which served as negative controls. At the end of surgery, tissue samples were taken from the bottom of the 'fluid collection bag' for microbiological analysis. RESULTS All 86 control samples were negative. Out of the samples taken from the bags, a pathogen could be detected in four patients (9.3%). All pathogens were detected after a surgery time lasting longer than 90 min. CONCLUSION We were able to show that fluid collection bags are a potential reservoir for bacteria in THA when surgery time was greater than a 90-min threshold. Our data suggest that the risks from fluid collection bags outweigh the advantages of using them. Therefore, we recommend against the use of fluid collection bags intraoperatively in primary THA.
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Affiliation(s)
- M M Ploeger
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - C Jacobs
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - M Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - E Kaup
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - T M Randau
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - M J Friedrich
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - G T Hischebeth
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - M D Wimmer
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany.
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Contamination of Irrigation Fluid During Primary Total Knee Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e027. [PMID: 30211391 PMCID: PMC6132336 DOI: 10.5435/jaaosglobal-d-17-00027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose: During surgical procedures, some amount of irrigation fluid leaks from the surgical site and accumulates on the sterile drapes. Whether these fluid collections show bacterial contamination over time in primary total knee arthroplasty remains unclear. Methods: In this study, we included 100 patients. We collected the samples of irrigation fluid before skin incision and every 30 minutes after the start of surgery. In addition, at the end of surgery, we evaluated the suction tip for bacterial contamination. After 3 months, we clinically evaluated all patients for periprosthetic joint infection. Results: Although the drapes were found to be sterile after 30 minutes, fluid residues on the surgical drapes show a contamination rate of 22% after 60 minutes and thus a marked correlation between advanced duration of surgery and bacterial contamination. The suction tip was contaminated with bacteria in 22% of cases. The spectrum of pathogens typical of periprosthetic joint infection could be demonstrated. Conclusion: Fluid surgical drape reservoirs were abacterial during the first 30 minutes but showed marked bacterial contamination over time. For total knee arthroplasty, we recommend regular replacement of the suction tip every 30 minutes. In addition, irrigation fluid reservoirs should not be withdrawn by suction 30 minutes after skin incision.
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Ratto N, Arrigoni C, Rosso F, Bruzzone M, Dettoni F, Bonasia DE, Rossi R. Total knee arthroplasty and infection: how surgeons can reduce the risks. EFORT Open Rev 2017; 1:339-344. [PMID: 28461965 PMCID: PMC5367521 DOI: 10.1302/2058-5241.1.000032] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Total joint arthroplasty (TJA) is one of the most common orthopaedic procedures. Nevertheless, several complications can lead to implant failure. Peri-prosthetic joint infections (PJI) certainly represent a significant challenge in TJA, constituting a major cause of prosthetic revision. The surgeon may have an important role in reducing the PJI rate by limiting the impact of significant risk factors associated to either the patient, the operative environment or the post-operative care. In the pre-operative period, several preventive measures may be adopted to manage reversible medical comorbidities. Other recognised pre-operative risk factors are urinary tract infections, intra-articular corticosteroid injections and nasal colonisation with Staphylococcus (S.) aureus, particularly the methicillin-resistant strain (MRSA). In the intra-operative setting, protective measures for PJI include antibiotic prophylaxis, surgical-site antisepsis and use of pre-admission chlorhexidine washing and pulsed lavage during surgery. In this setting, the use of plastic adhesive drapes and sterile stockinette, as well as using personal protection systems, do not clearly reduce the risk of infection. On the contrary, using sterile theatre light handles and splash basins as well as an increased traffic in the operating room are all associated with an increased risk for PJI. In the post-operative period, other infections causing transient bacteraemia, blood transfusion and poor wound care are considered as risk factors for PJI.
Cite this article: Ratto N, Arrigoni C, Rosso F, Bruzzone M, Dettoni F, Bonasia DE, Rossi R. Total knee arthroplasty and infection: how surgeons can reduce the risks. EFORT Open Rev 2016;1: 339-344 DOI: 10.1302/2058-5241.1.000032.
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Affiliation(s)
| | | | - Federica Rosso
- AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy
| | - Matteo Bruzzone
- AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy
| | - Federico Dettoni
- AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy
| | | | - Roberto Rossi
- AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy
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Salassa TE, Swiontkowski MF. Surgical attire and the operating room: role in infection prevention. J Bone Joint Surg Am 2014; 96:1485-92. [PMID: 25187588 DOI: 10.2106/jbjs.m.01133] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Although there is some evidence that scrubs, masks, and head coverings reduce bacterial counts in the operating room, there is no evidence that these measures reduce the prevalence of surgical site infection.➤ The use of gloves and impervious surgical gowns in the operating room reduces the prevalence of surgical site infection.➤ Operating-room ventilation plays an unclear role in the prevention of surgical site infection.➤ Exposure of fluids and surgical instruments to the operating-room environment can lead to contamination. Room traffic increases levels of bacteria in the operating room, although the role of this contamination in surgical site infection is unclear.
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Affiliation(s)
- Tiare E Salassa
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, Suite R200, Minneapolis, MN 55454. E-mail address for T.E. Salassa:
| | - Marc F Swiontkowski
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, Suite R200, Minneapolis, MN 55454. E-mail address for T.E. Salassa:
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Jonsson EÖ, Johannesdottir H, Robertsson O, Mogensen B. Bacterial contamination of the wound during primary total hip and knee replacement. Median 13 years of follow-up of 90 replacements. Acta Orthop 2014; 85:159-64. [PMID: 24650025 PMCID: PMC3967258 DOI: 10.3109/17453674.2014.899848] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Previous work has shown that despite preventive measures, intraoperative contamination of joint replacements is still common, although most of these patients seem to do well in follow-up of up to 5 years. We analyzed the prevalence and bacteriology of intraoperative contamination of primary joint replacement and assessed whether its presence is related to periprosthetic joint infection (PJI) on long-term follow-up. PATIENTS AND METHODS 49 primary total hip replacements (THRs) and 41 total knee replacements (TKRs) performed between 1990 and 1991 were included in the study. 4 bacterial swabs were collected intraoperatively during each procedure. Patients were followed up for joint-related complications until March 2011. RESULTS 19 of 49 THRs and 22 of 41 TKRs had at least 1 positive culture. Coagulase-negative staphylococci and Staphylococcus aureus were the most common organisms, contaminating 28 and 9 operations respectively. Where information was available, bacteria from 27 of 29 contaminated operations were susceptible to the prophylactic antibiotic administered. 13% of samples gathered before 130 min of surgery were contaminated, as compared to 35% collected after that time. 2 infections were diagnosed, both in TKRs. 1 of them may have been related to intraoperative contamination. INTERPRETATION Intraoperative contamination was common but few infections occurred, possibly due to the effect of prophylactic antibiotics. The rate of contamination was higher with longer duration of surgery. It appears that positive results from intraoperative swabs do not predict the occurrence of PJI.
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Affiliation(s)
- Eythor Örn Jonsson
- Department of Orthopedic Surgery, Landspitali University Hospital, Iceland.
| | | | - Otto Robertsson
- Department of Orthopedic Surgery, Landspitali University Hospital, Iceland.
| | - Brynjolfur Mogensen
- Faculty of Medicine, University of Iceland, Iceland.,Department of Emergency Medicine, Landspitali University Hospital, Reykjavik, Iceland.
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Alijanipour P, Karam J, Llinás A, Vince KG, Zalavras C, Austin M, Garrigues G, Heller S, Huddleston J, Klatt B, Krebs V, Lohmann C, McPherson EJ, Molloy R, Oliashirazi A, Schwaber M, Sheehan E, Smith E, Sterling R, Stocks G, Vaidya S. Operative environment. J Orthop Res 2014; 32 Suppl 1:S60-80. [PMID: 24464899 DOI: 10.1002/jor.22550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Glait SA, Schwarzkopf R, Gould S, Bosco J, Slover J. Is repetitive intraoperative splash basin use a source of bacterial contamination in total joint replacement? Orthopedics 2011; 34:e546-9. [PMID: 21902155 DOI: 10.3928/01477447-20110714-06] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Splash basins are used in arthroplasty cases to wash instruments. Several studies in the literature have shown these basins being a potential source of bacterial infection. This study assesses the risk of contamination of intraoperative splash basins used to wash and store instruments. A total of 46 random clean primary arthroplasty cases (32 hips, 13 knees, and 1 unicondylar knee) were studied by taking cultures of sterile splash basins as soon as they are opened (controls) and again at wound closure after instruments and debris have come into contact with the sterile water. All cultures were taken with sterile culture swabs and sent to the laboratory for aerobic, anaerobic, and fungal culture. Outcome measured was any positive culture. A total of 92 cultures from 46 cases were tested. Only 1 (2.17%) control culture, which grew Streptococcus viridans, was positive for bacterial growth. One of 46 samples (2.17%) taken at wound closure was positive for coagulase-negative Staphylococcus. Mean time between basin opening and wound closure was 180±45 minutes. For the 1 infected sample taken at the conclusion of the case, it was 240 minutes. Previous studies show contamination rates as high as 74% for splash basins used intraoperatively. Our study contradicts the belief that splash basins are a high source of infection, with only 2.17% of basins showing contamination. Splash basins can be a potential source of contamination, but the risk is not as high as previously cited in the orthopedic literature.
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Affiliation(s)
- Sergio A Glait
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York, USA
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