Scalpel blade contamination and risk of postoperative surgical site infection following abdominal incisions in dogs

Incidence of residual biologic debris and contamination of reused bipolar vessel sealing devices after ethylene oxide sterilization following splenectomy

OBJECTIVE

The aim of the present study was to quantify the amount of biologic debris present within disposable bipolar vessel sealing devices after each use for canine splenectomies and determine the aerobic bacterial load of the debris following instrument resterilization with ethylene oxide.

STUDY DESIGN

Prospective observational clinical study.

STUDY POPULATION

Client-owned dogs (n = 40) presenting to a single specialty hospital for open, routine, or emergency splenectomies.

METHODS

A total of 16 bipolar vessel sealing devices were randomly assigned to undergo one, two, three, or four splenectomies, manual hand cleanings, and ethylene oxide sterilizations before being dismantled. After final use and sterilization, each handset was agitated in phosphate-buffered saline before disassembly, which was submitted for aerobic culture. Following aseptic disassembly, all biological residue was photo-documented, collected, quantified using a subjective scoring system, and submitted for culture.

RESULTS

Biologic debris was present within the inner mechanics of all devices, specifically under the blade used for vessel transection. A linear increase in debris was not appreciated amongst devices used once versus devices used multiple times. None of the devices nor any of the biologic debris cultured positive following sterilization with ethylene oxide.

CONCLUSION

The presence of biologic debris was documented after the initial use of disposable bipolar vessel sealing devices, but no devices or debris yielded positive culture results following ethylene oxide sterilization after splenectomies.

CLINICAL SIGNIFICANCE

Increased risk of iatrogenic surgical site contamination from reused vessel sealing devices is unlikely when they have been cleaned and sterilized with ethylene oxide after up to four splenectomy surgeries.

"One blade, two cuts?" A multidisciplinary survey investigating practice variability of scalpel blade change for simultaneous excision of multiple skin lesions in the same patient

BACKGROUND

Skin cancer incidence increases globally, requiring effective preventive measures and evidence-based treatment strategies. Current guidelines advocate for surgical excision as a first-line treatment for most early skin cancers. The study investigated practices regarding changing scalpel blades when excising multiple skin lesions in the same patient during the same visit (CSB) and explored how beliefs about iatrogenic seeding influence individual norms of practice.

METHODS

A multidisciplinary survey was conducted among 173 medical specialists involved in skin cancer care. Participants provided demographic information, years of experience, and practices regarding CSB in four clinical scenarios (first excised tumor: basal cell carcinoma, squamous cell carcinoma, melanoma suspect, and evident melanoma). Practice variations based on specialty, experience, and beliefs about seeding risk were statistically assessed.

RESULTS

Surgeons exhibited a significantly higher tendency to change blades compared to non-surgeons across all diagnoses. Iatrogenic seeding (56.52%) and clinical training (18.84%) were the main reasons provided for CSB. Beliefs about seeding risk did not differ significantly between specialties.

CONCLUSIONS

Although the practice of CSB lacks strong scientific rationale, the approach to this practice significantly varies among different medical specialties. Healthcare professionals should critically evaluate and standardize evidence-based practices to ensure optimal patient care and mitigate potential harm.

No Link Between Inadvertent Surgical Glove Contamination and Surgical Site Infection in Patients Undergoing Elective Neurosurgical Operations

INTRODUCTION

Controllable factors associated with surgical site infections (SSIs) have focused on reducing contamination of the surgical field with potential pathogens. The aim of this prospective study is to determine the incidence of glove contamination in a series of elective neurosurgical operations and determine the relationship of such glove contamination to subsequent SSI. We hypothesize that contamination of surgical gloves is associated with subsequent SSI.

METHODS

In this prospective quality improvement study, gloves of the surgical team were swabbed for standard culture just prior to wound closure of elective neurosurgical operations. Patient characteristics, surgical details, and occurrence of subsequent SSIs were collected retrospectively from the electronic medical records. Data were analyzed with χ2 with Fisher's exact test and Student's t test.

RESULTS

Surgical glove contamination occurred in 10 of 96 elective neurosurgical cases (10.4%). SSIs occurred in 6 cases (6.2%), but no SSI occurred in a case in which surgical glove contamination occurred (P = 1). SSI was associated with younger patient age (P = 0.0448), and surgical glove contamination was associated with less resident experience (P = 0.0354).

CONCLUSIONS

Surgical glove contamination identified at the time of wound closure does not correlate with the development of subsequent SSI in elective neurosurgical operations.