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Lee JJ, Oladeji K, Finlay AK, Manasherob R, Amanatullah DF. Detecting contamination events during robotic total joint arthroplasty. Am J Infect Control 2024; 52:1025-1029. [PMID: 38663453 DOI: 10.1016/j.ajic.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Robot-assisted total joint arthroplasty (robotic-TJA) has become more widespread over the last 20 years due to higher patient satisfaction and reduced complications. However, robotic TJA may have longer operative times and increased operating room traffic, which are known risk factors for contamination events. Contamination of surgical instruments may be contact- or airborne-related with documented scalpel blade contamination rates up to 9%. The robot arm is a novel instrument that comes in and out of the surgical field, so our objective was to assess whether the robot arm is a source of contamination when used in robotic TJA compared to other surgical instruments. METHODS This was a prospective, single-institution, single-surgeon pilot study involving 103 robotic TJAs. The robot arm was swabbed prior to incision and after closure. Pre- and postoperative control swabs were also collected from the suction tip and scalpel blade. Swabs were incubated for 24 hours on tryptic soy agar followed by inspection for growth of any contaminating bacteria. RESULTS A contamination event was detected in 10 cases (10%). The scalpel blade was the most common site of contamination (8%) followed by the robot arm (2%) and suction tip (0%). DISCUSSION Robotic TJA is contaminated with bacteria at a rate around 10%. Although the robot arm is an additional source of potential contamination, the robot arm accrues bacterial contamination infrequently compared to the scalpel blade. CONCLUSION Contamination of the robot arm during robotic TJA is minimal when compared to contamination of the scalpel blade.
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Affiliation(s)
- Jonathan J Lee
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA
| | - Kingsley Oladeji
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA
| | - Andrea K Finlay
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA
| | - Robert Manasherob
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA
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Marable JK, Spoer DL, Harish V, Berger LE, Song DH, Fan KL. Sterile Draping of Operative Microscopes in Breast Free Flaps and Surgical Site Infections. Ann Plast Surg 2024:00000637-990000000-00535. [PMID: 39150794 DOI: 10.1097/sap.0000000000004067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
BACKGROUND Operative microscopes are traditionally draped in single-use plastic to prevent infection theoretically. The necessity of this routine in breast free flap surgery is unclear. Alternatively, sterile wrapping of microscope handles would reduce operating room waste and provide a more cost-effective and environmentally sustainable approach to sterility. This study aimed to determine whether the draping technique used during abdominally based free flaps (Ab-FF) influenced the rate of surgical site infections. METHODS We conducted a retrospective review of Ab-FF performed consecutively between March 2017 and August 2022. Patient demographics, comorbidities, perioperative data, and postoperative complications were collected. The primary outcomes included postoperative surgical site infections and environmental impact. RESULTS Of the 281 identified breasts reconstructed with Ab-FF, operating microscopes were sterilely covered with microscope drapes (n = 215) or handle covers (n = 66) composed of polyethylene-based plastic. Overall, postoperative infections occurred in 9.3% of cases (n = 26) in either the recipient breast (n = 11, 3.9%) or abdominal donor site (n = 15, 5.3%), primarily due to S. aureus and Streptococcus species. The handle (n = 6, 9.1%) and drape (n = 20, 9.3%) cohorts had similar infection rates with no sequelae of operative complications. In multivariate analysis, radiation was the only independent predictor of postoperative infection, while bilateral reconstructions were independently protective. Replacing a microscope drape with a handle reduces carbon emissions by 1276 grams of CO2 and direct costs by $7.84 per item. CONCLUSIONS The principles of "Lean and Green" surgery prioritize reducing operating room generated waste to achieve financial and environmental sustainability. This cohort study of 281 breast free flaps demonstrates that switching from whole microscope draping to handle wrapping was not associated with an increased rate or odds of infection. Adopting a microscope handle wrapping protocol decreased the carbon footprint and operative costs. The results of this study offer evidence to support adoption and further exploration of pragmatic, cost-effective, and sustainable approaches to microsurgical breast reconstruction.
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Affiliation(s)
- Julian K Marable
- From the Georgetown University School of Medicine, Washington, DC
| | | | - Varsha Harish
- From the Georgetown University School of Medicine, Washington, DC
| | | | - David H Song
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
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Dehghani B, DeAngelis RD, Hallman M, Karnuta JM, Minutillo GT, Alqazzaz A, Donegan DJ, Mehta S. Using Next-Generation Sequencing to Understand Infection Prevention in Surgical Treatment of Upper Extremity Fractures-A Prospective Cohort Study. J Am Acad Orthop Surg 2024; 32:e832-e838. [PMID: 39093461 DOI: 10.5435/jaaos-d-23-00703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 04/15/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Postoperative fracture site infection can lead to notable patient morbidity, increase cost of care, and further contribute to healthcare disparities globally. Dogma suggests surgical blades as a vehicle for introducing bacteria into the surgical site; however, there is a paucity of literature to support this claim. This study uses advanced DNA sequencing to detect bacterial DNA on surgical blades used in upper extremity fracture surgeries. METHODS This was a prospective study, conducted at a high-volume level 1 trauma center. All acute, closed upper extremity fractures requiring surgical stabilization were consecutively enrolled in a prospective fashion. The primary end point was the presence of bacterial DNA on the surgical blade using next-generation sequencing (NGS). At the time of surgery, two blades were sterilely opened. One blade served as the control while the other was used for the initial skin incision. Two negative control blades were opened directly into a sterile container. Two positive control blades were used for skin incision through known infections. All samples were sent for NGS analysis. RESULTS Forty patients were enrolled in this study. The median age was 33.5 years, and 30% were female; the median body mass index was 26.52. Humerus fractures were the most common injury (N = 17, 42.5%), followed by clavicle fractures (13, 32.5%) and radius/ulna fractures (10, 25.0%). NGS analysis revealed no contamination of test blades used for skin incision. Three control blades tested positive for bacterial DNA. Negative control blades tested negative for bacterial DNA (0/2); the positive control blades resulted positive for bacterial DNA contamination (2/2). CONCLUSION Surgical blades used for skin incision in the upper extremity are not contaminated with bacterial DNA as analyzed by NGS. This finding challenges previous surgical dogma regarding surgical blade contamination and supports that the same surgical blade can safely be used for deeper dissection. LEVEL OF EVIDENCE Level II study: IRB approval-IRB#848938.
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Affiliation(s)
- Bijan Dehghani
- From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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Deer TR, Russo MA, Sayed D, Pope JE, Grider JS, Hagedorn JM, Falowski SM, Al-Kaisy A, Slavin KV, Li S, Poree LR, Eldabe S, Meier K, Lamer TJ, Pilitsis JG, De Andrés J, Perruchoud C, Carayannopoulos AG, Moeschler SM, Hadanny A, Lee E, Varshney VP, Desai MJ, Pahapill P, Osborn J, Bojanic S, Antony A, Piedimonte F, Hayek SM, Levy RM. The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for the Mitigation of Complications of Neurostimulation. Neuromodulation 2024; 27:977-1007. [PMID: 38878054 DOI: 10.1016/j.neurom.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION The International Neuromodulation Society convened a multispecialty group of physicians based on expertise and international representation to establish evidence-based guidance on the mitigation of neuromodulation complications. This Neurostimulation Appropriateness Consensus Committee (NACC)® project intends to update evidence-based guidance and offer expert opinion that will improve efficacy and safety. MATERIALS AND METHODS Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when NACC last published guidelines) to October 2023. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence was scant. RESULTS The NACC examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. CONCLUSIONS The NACC recommends best practices regarding the mitigation of complications associated with neurostimulation to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA.
| | | | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Adnan Al-Kaisy
- Guy's and St. Thomas National Health Service (NHS) Foundation Trust, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA; Neurology Section, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | - Sean Li
- National Spine & Pain Centers, Shrewsbury, NJ, USA
| | - Lawrence R Poree
- Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA
| | - Sam Eldabe
- The James Cook University Hospital, Middlesbrough, UK
| | - Kaare Meier
- Department of Anesthesiology (OPINord), Aarhus University Hospital, Aarhus, Arhus, Denmark; Department of Neurosurgery (Afd. NK), Aarhus University Hospital, Aarhus, Arhus, Denmark
| | | | | | - Jose De Andrés
- Valencia School of Medicine, Anesthesia Critical Care and Pain Management Department, General University Hospital, Valencia, Spain
| | | | - Alexios G Carayannopoulos
- Department of Physical Medicine and Rehabilitation and Comprehensive Spine Center, Rhode Island Hospital, Providence, RI, USA; Brown University Warren Alpert Medical School (Neurosurgery), Providence, RI, USA
| | - Susan M Moeschler
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir Hadanny
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Eric Lee
- Mililani Pain Center, Mililani, HI, USA
| | - Vishal P Varshney
- Anesthesiology and Pain Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Virginia Hospital Center, Monument Research Institute, George Washington University School of Medicine, Arlington, VA, USA
| | - Peter Pahapill
- Functional Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Osborn
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Stana Bojanic
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ajay Antony
- The Orthopaedic Institute, Gainesville, FL, USA
| | - Fabian Piedimonte
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Salim M Hayek
- Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH, USA
| | - Robert M Levy
- Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA
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Lee JY, Yun SH, Kang JW, Kong GM. Bacterial contamination of surgical gloves during clean orthopedic surgery. Infect Control Hosp Epidemiol 2024:1-3. [PMID: 38563113 DOI: 10.1017/ice.2024.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This study examines the presence of bacterial contamination on surgical gloves and suggests appropriate measures for an aseptic surgical environment. To prevent glove contamination during surgery, surgeons and assistants should change gloves periodically, and scrub nurses should be careful when opening packages and handing over implants.
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Affiliation(s)
- Jee Young Lee
- Department of Microbiology, College of Medicine, Kosin University, Busan, Korea
| | - Sang Hee Yun
- Department of Microbiology, College of Medicine, Kosin University, Busan, Korea
| | - Jae Won Kang
- Department of Orthopaedic Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Gyu Min Kong
- Department of Orthopaedic Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
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Biehl K, Rogovskyy AS, Jeffery N, Douglas P, Thieman Mankin KM. Influence of closed glove exchange on bacterial contamination of the hands of the surgical team. Vet Surg 2023; 52:747-755. [PMID: 37080898 DOI: 10.1111/vsu.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/09/2023] [Accepted: 04/02/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE To determine if closed glove exchange (CGE) increases hand contamination. STUDY DESIGN Prospective experimental study. SAMPLE POPULATION Surgical teams participating in 65 individual surgical procedures were included, resulting in 200 individual enrollments. METHODS At the completion of surgery, gloves were removed and hands were swabbed. The inside of the gown cuff was swabbed. Each participant regloved, using a closed gloving technique. The new gloves were removed, and hands were swabbed for culture a second time. Swabs underwent standard bacterial culture. RESULTS Before glove exchange, or baseline, contamination was found on 17/200 dominant hands and 13/200 nondominant hands. After performing CGE, contamination was found on 14/200 and 15/200 dominant and nondominant hands, respectively. No difference was detected between the number of CFUs cultured from a surgeon's hands before CGE and the number of CFUs cultured from a surgeon's hands post-CGE (one sided sign test, p = .61). Twelve (12) different bacterial species were identified, the most common were Staphylococcus spp. (97/154; 63%). CONCLUSION Closed glove exchange did not increase bacterial hand contamination over baseline levels. CLINICAL SIGNIFICANCE We found no evidence to support discontinuing CGE.
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Affiliation(s)
- Kathryn Biehl
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Artem S Rogovskyy
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Nicholas Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Pamela Douglas
- Veterinary Medical Teaching Hospital, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Kelley M Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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Thierbach M, Müller M, Stange R, Kronenberg D, Aurich M, Wildemann B. Wrap It! Preventive Antimicrobial Treatment Shows No Negative Effects on Tenocytes and Tendons-A Comprehensive Approach. J Clin Med 2023; 12:4104. [PMID: 37373797 DOI: 10.3390/jcm12124104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Although the rate of infection after the reconstruction of a ruptured anterior cruciate ligament (ACL) is low, prophylactic incubation of the graft with vancomycin (Vanco-wrap or vancomycin soaking) is routinely performed. A cytotoxic effect of vancomycin is reported for several cell types, and the prophylactic treatment might prevent infection but harm the tissue and cells. AIM A comprehensive study was performed to investigate the effect of vancomycin on tendon tissue and isolated tenocytes using cell viability, molecular and mechanical analysis. MATERIAL AND METHODS Rat tendons or isolated tenocytes were incubated in increasing concentrations of vancomycin (0-10 mg/mL) for different times, and cell viability, gene expression, histology and Young's modulus were analyzed. RESULTS The clinically used concentration of vancomycin (5 mg/mL for 20 min) had no negative effect on cell viability in the tendons or the isolated tenocytes, while incubation with the toxic control significantly reduced cell viability. Increasing the concentration and prolonging the incubation time had no negative effect on the cells. The expression of Col1a1, Col3a1 and the tenocyte markers mohawk, scleraxis and tenomodulin was not affected by the various vancomycin concentrations. The structural integrity as measured through histological and mechanical testing was not compromised. CONCLUSION The results proved the safe application of the Vanco-wrap on tendon tissue. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Manuela Thierbach
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital/Friedrich Schiller University Jena, 07747 Jena, Germany
| | - Michelle Müller
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital/Friedrich Schiller University Jena, 07747 Jena, Germany
| | - Richard Stange
- Department of Regenerative Musculoskeletal Medicine, Institute for Musculoskeletal Medicine, Westfälische Wilhelms-Universität Münster, 48149 Münster, Germany
| | - Daniel Kronenberg
- Department of Regenerative Musculoskeletal Medicine, Institute for Musculoskeletal Medicine, Westfälische Wilhelms-Universität Münster, 48149 Münster, Germany
| | - Matthias Aurich
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital/Friedrich Schiller University Jena, 07747 Jena, Germany
- DOUW-Section of Trauma and Reconstructive Surgery, University Hospital Halle (Saale), 06120 Halle, Germany
- BG Trauma Center Bergmannstrost, 06112 Halle, Germany
| | - Britt Wildemann
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital/Friedrich Schiller University Jena, 07747 Jena, Germany
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Corcoll F, Pérez-Prieto D, Karbysheva S, Trampuz A, Fariñas O, Monllau JC. Are Hamstring Grafts a Predisposing Factor to Infection in R-ACL Surgery? A Comparative In Vitro Study. Pathogens 2023; 12:761. [PMID: 37375451 DOI: 10.3390/pathogens12060761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The objective of the present study was to evaluate the formation of biofilms in bone patellar tendon bone grafts (BPTB grafts), and to compare it to the formation of biofilm formation in quadrupled hamstring anterior cruciate ligament grafts (4×Ht graft). METHODS A descriptive in vitro study was conducted. One 4×Ht graft and one BPTB graft were prepared. They were then contaminated with a strain of S. epidermidis. Later, a quantitative analysis was conducted by means of microcalorimetry and sonication with plating. Additionally, a qualitative analysis was conducted by means of electron microscopy. RESULTS No significant differences were found between the bacterial growth profiles of the 4×Ht graft and the BPTB graft in microcalorimetry and colony counting. In the samples analyzed with electron microscopy, no specific biofilm growth pattern was identified upon comparing the BPTB graft to the 4×Ht graft. CONCLUSIONS There were no significant differences found at either the quantitative or qualitative level when comparing bacterial growth in the BPTB graft to that in the 4×Ht graft. Therefore, the presence of sutures in the 4×Ht graft cannot be established as a predisposing factor for increased biofilm growth in this in vitro study.
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Affiliation(s)
- Ferran Corcoll
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar-Universitat Autònoma de Barcelona (UAB), 08003 Barcelona, Spain
| | - Daniel Pérez-Prieto
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar-Universitat Autònoma de Barcelona (UAB), 08003 Barcelona, Spain
| | - Svetlana Karbysheva
- Center for Musculoskeletal Surgery, Charite'-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charite'-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Oscar Fariñas
- Banc de Sang i Teixits de Catalunya, Barcelona (BST), 08005 Barcelona, Spain
| | - Juan Carles Monllau
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar-Universitat Autònoma de Barcelona (UAB), 08003 Barcelona, Spain
- Departament de Ciències Morfològiques, Edifici M Facultat de Medicina Avinguda Can Domènech S/N Campus de la Universitat Autònoma de Barcelona (UAB) Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
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Park JW, Ko YS, Park S, Kim SH, Lee YK, Koo KH. Cemented versus Cementless Total Hip Arthroplasty for Femoral Head Osteonecrosis: A Study Based on National Claim Data in South Korea. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00001. [PMID: 37134143 PMCID: PMC10155893 DOI: 10.5435/jaaosglobal-d-23-00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION The purpose of this study was to compare the rates of revision, periprosthetic joint infection (PJI), and periprosthetic fracture (PPF) between patients with osteonecrosis of the femoral head (ONFH) undergoing noncemented total hip arthroplasty (THA) and cemented THA using a national claim data in South Korea. METHODS We identified patients who received THA for ONFH from January 2007 to December 2018 using ICD diagnosis codes and procedural codes. Patients were categorized into two groups according to the fixation method: with or without cement. The survivorship of THA was calculated using the following end points: revision of both the cup and stem, revision of the single component, any type of revision, PJI, and PPF. RESULTS A total of 40,606 patients: 3,738 patients (9.2%) with cement and 36,868 patients (90.7%) without cement, received THA for ONFH. The mean age of the noncemented fixation group (56.2 ± 13.2 years) was significantly lower than that of the cemented fixation group (57.0 ± 15.7 years, P = 0.003). The risk of revision and PJI was notably higher in cemented THA (hazard ratio: 1.44 [1.21 to 1.72] and 1.66 [1.36 to 2.04], respectively). Noncemented THA had a higher 12-year survivorship compared with cemented THA with any revision and PJI as the end point. DISCUSSION Noncemented fixation had better survivorship than cemented fixation in patients with ONFH.
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Affiliation(s)
- Jung-Wee Park
- From the Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea (Dr. J-W. Park, Dr. Ko, Dr. Lee, and Dr. Koo); the Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Korea (Ms. S. Park); the Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea (Mr. Kim); the Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea (Dr. Lee); and the Department of Orthopaedic Surgery, Kay Joint Center, Cheil Orthopaedic Hospital, Seoul, South Korea (Dr. Koo)
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Vargas-Reverón C, Font-Vizcarra L, Morata L, Fernández-Valencia JA, Soriano A, Muñoz-Mahamud E. Do Cultures Obtained During Primary THA Predict the Likelihood of Revision? Clin Orthop Relat Res 2023; 481:778-785. [PMID: 36278949 PMCID: PMC10013665 DOI: 10.1097/corr.0000000000002460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/23/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND There can be unexpectedly positive culture results during elective hip arthroplasty, but the degree to which these are associated with an increased risk of subsequent premature revision is not known. QUESTION/PURPOSE Are unexpectedly positive culture results obtained during elective THA associated with an increased likelihood of revision within 5 years of the procedure? METHODS Between March 2007 and March 2011, the hip unit at our institution performed elective primary THA in 829 patients. We systematically collected three samples in 52% (428 of 829) of the interventions. Of those, 26 patients were excluded because of sampling errors; 94% (402 of 428) had samples that were collected systematically and were eligible for the study. We only considered one hip randomly in bilateral procedures (4% [15 of 428]); patients presenting with acute (< 3 months) periprosthetic joint infection undergoing open debridement (4% [16 of 402]) and patients who died before 5 years of follow-up (2% [seven of 402]) were excluded from the study, leaving 91% (364 of 402) eligible for analysis in this retrospective study of a previous prospective trial. No patient included in the final analysis was lost to follow-up within 5 years from the index surgery. The patient group consisted of 52% (188 of 364) women, with a mean ± SD age of 64.8 ± 13.9 years. RESULTS Positives culture results were associated with a higher risk of revision within 5 years of the index surgery. The proportion of revision surgery was higher in the group with positive culture results than in those with negative results (10% [eight of 77] versus 2% [seven of 290]; p = 0.01). The difference was mainly attributable to a higher proportion of aseptic loosening in those with positive culture results than in those with negative results (8% [six of 74] versus 1% [four of 290]; p = 0.01). After a multivariable analysis, the only independent variable associated with 5-year revision surgery was the presence of positive results during THA (odds ratio 4.9 [95% confidence interval 1.72 to 13.99]). CONCLUSION Our findings suggest that bacterial contamination during THA is associated with an increased likelihood of early revision. This higher risk of revision is mainly because of presumed aseptic loosening; thus, efforts should focus on the need to rule out infection. These results not only open new questions that should be answered in new prospective and well-designed studies, but also may help to better select patients to obtain a more favorable outcome after THA. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Caribay Vargas-Reverón
- Department of Orthopedics and Trauma Surgery, Bone and Joint Infection Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Lluís Font-Vizcarra
- Bone and Joint Infection Unit, Department of Orthopedics. Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Laura Morata
- Department of Infectious Diseases, Bone and Joint Infection Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jenaro A. Fernández-Valencia
- Department of Orthopedics and Trauma Surgery, Bone and Joint Infection Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Bone and Joint Infection Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Ernesto Muñoz-Mahamud
- Department of Orthopedics and Trauma Surgery, Bone and Joint Infection Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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A Review of Evidence for Infection Reduction With Vancomycin-treated Anterior Cruciate Ligament Grafts. J Am Acad Orthop Surg 2022; 30:e1571-e1579. [PMID: 36476465 DOI: 10.5435/jaaos-d-22-00463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/10/2022] [Indexed: 12/13/2022] Open
Abstract
Septic arthritis after anterior cruciate ligament (ACL) reconstruction is a rare but devastating complication. Several risk factors and known sources of infection have been identified in the literature. There is growing interest and supportive evidence for a targeted invention aimed at graft decontamination, which has led some surgeons to adopt the use of antibiotic solution soaks and/or wraps applied to ACL grafts before graft implantation in an attempt to reduce the risk of postoperative infection. Despite this, adoption of this technique remains relatively low among surgeons because of a variety of factors: (1) lack of awareness, (2) confusion over optimal protocols, (3) concern for graft viability and clinical outcomes, and (4) efforts to minimize the cost of surgery. However, recently published literature demonstrates notable risk reduction for infection, acceptable safety, no detrimental effect on clinical outcomes, and overall cost-effectiveness with the use of vancomycin graft soaks and wraps. Currently, there is a lack of consensus for clinical protocols, and the protocol that is most efficacious remains unclear. The purpose of this review article was to present the current evidence for ACL graft treatment with vancomycin for the prevention of postoperative infection.
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Collins AP, Simpson J, Richey B, Zaruta D, Levin S, Lewellyn B, Service BC. Efficacy of antimicrobial washes before shoulder surgery against Cutibacterium: a systematic review and meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:315-322. [PMID: 37588870 PMCID: PMC10426554 DOI: 10.1016/j.xrrt.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Cutibacterium acnes is a commensal intradermal microorganism that is commonly isolated at revision shoulder arthroplasty. Standard practice chlorhexidine gluconate (CHG) skin preparation agents have limited effectiveness at eradicating C. acnes in the dermis. Benzoyl peroxide (BPO) has demonstrated effectiveness against C. acnes. This meta-analysis compares the efficacy of at-home shoulder decolonization before surgery using CHG vs. BPO to reduce shoulder C. acnes burden. Methods This was a Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review. PubMed and MEDLINE databases were searched for studies evaluating the effects of CHG and BPO in reducing C. acnes at the shoulder. Trial results were extracted and pooled using a random effects model, separating data from randomized controlled trials (RCTs) and non-RCTs. Methodologic quality of studies was assessed using the Cochrane Risk of Bias Assessment Tools. Results Ten studies (589 patients) were included. RCTs showed that both BPO and CHG led to significant reductions in culture positivity compared with negative controls (risk ratio [RR] with 95% confidence interval [CI] = 0.20 [0.13, 0.30], P < .0001 and 0.46 [0.37, 0.57], P < .0001, respectively). Non-RCT data demonstrated similar results comparing BPO and CHG to the control (RR with 95% CI = 0.34 [0.21, 0.57], P < .0001 and 0.31 [0.20, 0.49], P < .0001, respectively). Comparing BPO and CHG, RCT data showed a significant reduction in culture positivity with BPO (RR with 95% CI = 0.46 [0.27, 0.77], P < .009). Of RCTs, 5 were low and one was of moderate risk of bias. Of non-RCTs, 3 had low risk of bias, whereas one had moderate risk of bias. Conclusion This review demonstrated that preoperative CHG and BPO can reduce C. acnes at the shoulder. However, BPO exhibits greater efficacy than CHG, potentially because of the compound's ability to penetrate the dermis. BPO is a simple and economical agent that may reduce joint exposure to C. acnes in shoulder surgery.
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Affiliation(s)
| | - Jeffrey Simpson
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
| | - Bradley Richey
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
| | - Douglas Zaruta
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
| | - Samantha Levin
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
| | - Brett Lewellyn
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
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Boekel P, Ek ET. Contamination Associated With Glove Changing Techniques in the Operating Theatre. Front Surg 2022; 9:839040. [PMID: 35392064 PMCID: PMC8980212 DOI: 10.3389/fsurg.2022.839040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Sterility of the operative field during surgery is imperative in reducing the risk of infection. Most commonly, double gloves are worn by surgeons. When contamination occurs, the top gloves are changed intra-operatively. No studies have investigated which glove changing technique is best. Therefore, in this study, we aim to identify which top glove changing technique causes the least surface contamination. Methods Glitterbug™ (UV fluorescent powder) was applied to the top gloves of 3 individuals who changed their top gloves according to a randomised method – Method 1: 3 pairs worn, remove the outer pair; Method 2: 2 pairs worn, remove the top glove, replace unassisted; and Method 3: 2 pairs worn, remove the top glove, and replace assisted by a scrub nurse. A blinded investigator inspected for Glitterbug™ contamination under UV light. Results Two hundred and ten trials were performed and two types of contamination were identified, namely, direct contact and airborne spread. For absolute contamination, Method 1 had 59/64 (92%) contaminated trials, Method 2 had 49/65 (75%) contaminated trials, and Method 3 had 64/81 (79%) contaminated trials. This was statistically significant (p = 0.031). For direct contamination only, Method 1 had 38/64 (59%) contaminated trials, Method 2 had 24/65 (37%) contaminated trials, and Method 3 had 20/81 (25%) contaminated trials. This was statistically significant (p < 0.0001). Conclusions Method 2 had a statistically significant lower contamination rate overall, with Method 3 having the lowest direct contamination rate. We believe that wearing 2 gloves, removing the top glove and replacing it, either assisted or unassisted, could decrease surface contamination of the sterile field.
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Affiliation(s)
- Pamela Boekel
- Department of Orthopaedic Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Pamela Boekel
| | - Eugene T. Ek
- Department of Orthopaedic Surgery, Austin Hospital, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia
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Santoshi JA, Behera P, Gupta A, Sharma A, Verma VK, Agrawal U, Purwar S. Intraoperative Surgical Wound Contamination May Not Lead to Surgical-Site Infection in Patients Undergoing Clean Orthopaedic Procedures: A Prospective Clinical Study. J Lab Physicians 2022; 14:284-289. [PMID: 36119426 PMCID: PMC9473933 DOI: 10.1055/s-0042-1742422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectives
Surgical-site infections (SSIs) can complicate virtually any surgical procedure. While SSI can result from numerous causes, contamination of the surgical field can also contribute to it. Intraoperative bacterial contamination during clean orthopaedic procedures can be detected using perioperative cultures. We hypothesized that perioperative cultures could be used to predict possibility of development of SSI in patients undergoing clean orthopaedic surgeries.
Materials and Methods
We conducted a prospective cohort study at a tertiary care hospital over a 2-year period. Intraoperative surgical wound lavage fluid and closed suction drain tip obtained in the postoperative period were sent for aerobic culture. All patients were followed up to look for the development of SSI for a period of at least 30 days for those undergoing nonimplant surgery, and 90 days for those with implant surgery.
Statistical Analysis
Means with standard deviation of the continuous data were calculated. Fisher's exact test and chi-square test were used for the analysis of the categorical variables. Relative risk and odds ratio were calculated to evaluate the association of the parameters under study with SSI.
Results
A total of 384 patients satisfying the inclusion and exclusion criteria were included. Perioperative cultures detected surgical wound contamination in 39 patients (10.1%). Forty-five patients (11.7%) developed SSI during the follow-up period. Skin commensals constituted 59% of perioperative contaminants and accounted for 20% of the SSIs. The relative risk of developing SSI with perioperative contamination was 0.41 (95% confidence interval: 0.09–1.63).
Conclusion
Intraoperative surgical-site contaminants could be detected using perioperative cultures. However, these contaminants did not lead to SSI. Timely treatment of perioperative contamination with appropriate antibiotics and local wound care probably helped in the reduction of SSI.
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Affiliation(s)
- John Ashutosh Santoshi
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Prateek Behera
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Ayush Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Archa Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Virendra Kumar Verma
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Udit Agrawal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Shashank Purwar
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Ferro FP, Bessa FS, Miyahara H, Ejnisman L, Vicente JR, Croci AT. Multiple deep tissue cultures in primary total hip arthroplasty: prognostic value for periprosthetic infection. Hip Int 2022; 32:45-50. [PMID: 32538159 DOI: 10.1177/1120700020932110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The risk of infection after total hip replacement (THR) is significant, with negative impact on quality of life and high costs. Bacteria can contaminate the surgical site despite aseptic techniques; however, there is debate regarding the benefit of identifying bacteria during the primary procedure. Although taking multiple samples for culture is a well-established practice in revision arthroplasty, doing so in primary cases remains controversial. We aimed to investigate whether there is a prognostic value in the culture of samples taken during primary THR, seeking a correlation between the positivity of the cultures and subsequent prosthetic joint infection (PJI). METHODS Deep samples (capsule, femoral and acetabular bone) were collected from 426 patients undergoing elective primary THR. Follow-up was at least 3 years. Microbiological profiles of cultures were analysed. Patient data were reviewed for the identification of risk factors presumably associated with a higher risk of PJI. RESULTS 54 surgeries (12.6%) had positive cultures. 16 cases (3.8%) developed infection, of which 5 had a positive culture in the primary surgery. Infection rate was 9.3% in patients with positive culture and 3% in those with negative culture (p < 0.05), with an odds ratio of 3.34 (95% CI, 1.09-10.24). Patients with previous hip surgery had an infection rate of 8.5%, compared to 2.9% in patients with no previous surgery (p < 0.05). CONCLUSIONS Routinely harvesting microbiologic samples in primary THR is not justified, as it has no consequence in clinical decision for most patients. It might be recommended in selected cases that are suspected to be at high risk for infection, especially previously operated patients (conversion arthroplasty).
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Affiliation(s)
- Fernando P Ferro
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
| | - Felipe S Bessa
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
| | - Hélder Miyahara
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
| | - Leandro Ejnisman
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
| | - Jose Rn Vicente
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
| | - Alberto T Croci
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
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Melin S, Haase I, Nilsson M, Claesson C, Östholm Balkhed Å, Tobieson L. Cryopreservation of autologous bone flaps following decompressive craniectomy: A new method reduced positive cultures without increase in post-cranioplasty infection rate. BRAIN AND SPINE 2022; 2:100919. [PMID: 36248144 PMCID: PMC9560573 DOI: 10.1016/j.bas.2022.100919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/11/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022]
Abstract
Introduction Cranioplasty (CP) after decompressive craniectomy (DC) is a common neurosurgical procedure. Implementation of European Union (EU) directives recommending bacterial cultures before cryopreservation, lead to increased number of autologous bone flaps being discarded due to positive cultures. A new method for handling bone flaps prior to cryopreservation, including the use of pulsed lavage, was developed. Research question The aim was to evaluate the effect of a new method on proportion of positive bacterial cultures and surgical site infection (SSI) following CP surgery. Material and methods Sixty-one bone flaps from 53 consecutive DC surgery patients were retrospectively included and the study period was divided into before and after method implementation. Patient demographics, laboratory and culture results, type of CP and occurrence of SSI were analyzed. Results Twenty-six and 18 bone flaps were available for analysis during the first and second period, respectively. The proportion of positive bacterial cultures was higher in the first period compared to the second (n = 9(35%) vs 0(0%); p = 0.001), and thus the use of custom made implants was considerably higher in the first study period (p = 0.001). There was no difference in the frequency of post-cranioplasty SSI between the first and second study period (n = 3 (11.5%) vs 1 (4.8%), p = 0.408). Discussion and conclusion The new method for handling bone flaps resulted in a lower frequency of positive bacterial cultures, without increased frequency of post-cranioplasty SSI, thus demonstrating it is safe to use, allows compliance with the EU-directives, and may reduce unnecessary discarding of bone flaps. New method of bone flap handling and preservation reduced positive bacterial cultures from 35% to 0%. The new method used pulsed lavage of bone flap with saline solution and subsequent swab culture. There was no increase in post-cranioplasty surgical site infection following introduction of the new method.
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Affiliation(s)
- Sofia Melin
- Department of Neurosurgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ismene Haase
- Department of Anaesthesiology and Intensive Care in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Martin Nilsson
- Department of Neurosurgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Carina Claesson
- Department of Clinical Microbiology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Åse Östholm Balkhed
- Department of Infectious Diseases in Östergötland, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lovisa Tobieson
- Department of Neurosurgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Corresponding author. Department of Neurosurgery, University Hospital in Linköping, 581 85, Linköping, Sweden.
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Alomar AZ, Alfayez SM, Binnasser A, Aljassir FF. INTRAOPERATIVE EVALUATION AND LEVEL OF CONTAMINATION DURING TOTAL KNEE ARTHROPLASTY. ACTA ORTOPÉDICA BRASILEIRA 2022; 30:e243232. [PMID: 35864825 PMCID: PMC9270042 DOI: 10.1590/1413-785220223001e243232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
Introduction: Despite numerous articles on intraoperative contamination in total knee arthroplasty (TKA) procedures, the available data on tissue contamination are scarce and mainly based on evaluating bacteriological swabs. Methods: Two hundred and forty specimens, divided between bone and soft tissue, were obtained from 40 consecutive unilateral primaries TKAs. The specimens were evaluated for aerobic and anaerobic bacterial growth. Colony-forming units/gram (CFU/g) were calculated on the contaminated specimens to determine the level of contamination. Results: The contamination rate in intraoperative specimens was 15% during TKA. The contamination level had a mean of 10.6 and a median of 5, ranging from 1-70 CFU/g. The most common contaminating organisms in all samples were Staphylococcus aureus (38.9%) and Staphylococcus epidermidis (30.6%). No clinical infections were detected in TKAs in the follow-up period. Conclusion: The contamination rate during TKA is relatively high, despite the practice of standard preventive measures. Contamination levels, measured by CFU/g, are considered low when compared to the infection threshold of 105 reported in the literature. However, contamination should not be underestimated due to the presence of foreign bodies (implants), which are known to significantly lower this threshold. Level of evidence IV; case series .
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Affiliation(s)
| | - Saud M. Alfayez
- King Saud University, Saudi Arabia; McGill University, Canada
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Smirnova VV, Chausov DN, Serov DA, Kozlov VA, Ivashkin PI, Pishchalnikov RY, Uvarov OV, Vedunova MV, Semenova AA, Lisitsyn AB, Simakin AV. A Novel Biodegradable Composite Polymer Material Based on PLGA and Silver Oxide Nanoparticles with Unique Physicochemical Properties and Biocompatibility with Mammalian Cells. MATERIALS (BASEL, SWITZERLAND) 2021; 14:6915. [PMID: 34832317 PMCID: PMC8620072 DOI: 10.3390/ma14226915] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 02/08/2023]
Abstract
A method for obtaining a stable colloidal solution of silver oxide nanoparticles has been developed using laser ablation. The method allows one to obtain nanoparticles with a monomodal size distribution and a concentration of more than 108 nanoparticles per mL. On the basis of the obtained nanoparticles and the PLGA polymer, a nanocomposite material was manufactured. The manufacturing technology allows one to obtain a nanocomposite material without significant defects. Nanoparticles are not evenly distributed in the material and form domains in the composite. Reactive oxygen species (hydrogen peroxide and hydroxyl radical) are intensively generated on the surfaces of the nanocomposite. Additionally, on the surface of the composite material, an intensive formation of protein long-lived active forms is observed. The ELISA method was used to demonstrate the generation of 8-oxoguanine in DNA on the developed nanocomposite material. It was found that the multiplication of microorganisms on the developed nanocomposite material is significantly decreased. At the same time, the nanocomposite does not inhibit proliferation of mammalian cells. The developed nanocomposite material can be used as an affordable and non-toxic nanomaterial to create bacteriostatic coatings that are safe for humans.
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Affiliation(s)
- Veronika V. Smirnova
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova Str. 38, 119991 Moscow, Russia; (V.V.S.); (D.N.C.); (D.A.S.); (V.A.K.); (P.I.I.); (R.Y.P.); (O.V.U.); (M.V.V.)
| | - Denis N. Chausov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova Str. 38, 119991 Moscow, Russia; (V.V.S.); (D.N.C.); (D.A.S.); (V.A.K.); (P.I.I.); (R.Y.P.); (O.V.U.); (M.V.V.)
| | - Dmitriy A. Serov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova Str. 38, 119991 Moscow, Russia; (V.V.S.); (D.N.C.); (D.A.S.); (V.A.K.); (P.I.I.); (R.Y.P.); (O.V.U.); (M.V.V.)
| | - Valery A. Kozlov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova Str. 38, 119991 Moscow, Russia; (V.V.S.); (D.N.C.); (D.A.S.); (V.A.K.); (P.I.I.); (R.Y.P.); (O.V.U.); (M.V.V.)
- Department of Fundamental Science, Bauman Moscow State Technical University, 2-nd Baumanskaya Str. 5, 105005 Moscow, Russia
| | - Petr I. Ivashkin
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova Str. 38, 119991 Moscow, Russia; (V.V.S.); (D.N.C.); (D.A.S.); (V.A.K.); (P.I.I.); (R.Y.P.); (O.V.U.); (M.V.V.)
| | - Roman Y. Pishchalnikov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova Str. 38, 119991 Moscow, Russia; (V.V.S.); (D.N.C.); (D.A.S.); (V.A.K.); (P.I.I.); (R.Y.P.); (O.V.U.); (M.V.V.)
| | - Oleg V. Uvarov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova Str. 38, 119991 Moscow, Russia; (V.V.S.); (D.N.C.); (D.A.S.); (V.A.K.); (P.I.I.); (R.Y.P.); (O.V.U.); (M.V.V.)
| | - Maria V. Vedunova
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova Str. 38, 119991 Moscow, Russia; (V.V.S.); (D.N.C.); (D.A.S.); (V.A.K.); (P.I.I.); (R.Y.P.); (O.V.U.); (M.V.V.)
- Institute of Biology and Biomedicine, Lobachevsky State, University of Nizhni Novgorod, 23 Gagarin Ave., 603950 Nizhny Novgorod, Russia
| | - Anastasia A. Semenova
- V. M. Gorbatov Federal Research Center for Food Systems of the Russian Academy of Sciences, 109316 Moscow, Russia; (A.A.S.); (A.B.L.)
| | - Andrey B. Lisitsyn
- V. M. Gorbatov Federal Research Center for Food Systems of the Russian Academy of Sciences, 109316 Moscow, Russia; (A.A.S.); (A.B.L.)
| | - Alexander V. Simakin
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova Str. 38, 119991 Moscow, Russia; (V.V.S.); (D.N.C.); (D.A.S.); (V.A.K.); (P.I.I.); (R.Y.P.); (O.V.U.); (M.V.V.)
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Baseri N, Meysamie A, Campanile F, Hamidieh AA, Jafarian A. Bacterial contamination of bone allografts in the tissue banks: a systematic review and meta-analysis. J Hosp Infect 2021; 123:156-173. [PMID: 34752801 DOI: 10.1016/j.jhin.2021.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/02/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bone allografts are harvested and transplanted under sterile conditions. However, the risk of bacterial contamination of grafts during these processes is a health concern. Bioburden testing and bacterial contamination detection are conducted to ensure allograft sterility. AIM The present study aimed to determine the incidence of bacterial contamination in bone allografts based on different classifications. METHODS PROSPERO registration number was received for the study. Systematic searches were conducted in PubMed and EMBASE databases with relevant keywords from January 2000 to March 2021. After choosing related studies according to the PRISMA flow diagram, Stata software was used for data analysis. We considered I2 ˃ 50% as heterogeneity between studies. FINDINGS The overall incidence of bacterial contamination was 12.6% (95% CI 0.100, 0.152) among 19,805 bone allografts of 17 studies. The bacterial contamination rate among bone allografts was 10.8% before 2010 and 14.7% in 2010-March 2021. The contamination frequency in Asia, Europe, and Australia was 11.5%, 14.3%, and 5.2%, respectively. Bone contamination rates were higher in cadaver donors (19.9%), retrieval time sampling (13.5%), and swab samples (13.2%) compared to those in living donors (7.5%), implantation time sampling (6.9%), and bone fragments cultures (6.3%). Bacterial contamination was recovered 24.4%, 19.7%, 13.2%, and 21% from tibia, fibula, femoral, and other bones, respectively. Staphylococcus spp. was the predominant isolated bacteria from bones (63.2% of all isolated genera), followed by Propionibacterium spp. (10.6%). CONCLUSION The high contamination of bone allografts is a health concern, indicating the need for more health monitoring and improvement of standards.
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Affiliation(s)
- Neda Baseri
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging infectious diseases, Pasteur Institute of Iran, Tehran, Iran; National Reference laboratory for Plague, Tularemia and Q fever, Research Centre for Emerging and Reemerging infectious diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran
| | - Alipasha Meysamie
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Floriana Campanile
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Medical Molecular Microbiology and Antibiotic Resistance laboratory (MMARLab), University of Catania, Catania, Italy
| | - Amir Ali Hamidieh
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran; Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arefeh Jafarian
- Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Chausov DN, Burmistrov DE, Kurilov AD, Bunkin NF, Astashev ME, Simakin AV, Vedunova MV, Gudkov SV. New Organosilicon Composite Based on Borosiloxane and Zinc Oxide Nanoparticles Inhibits Bacterial Growth, but Does Not Have a Toxic Effect on the Development of Animal Eukaryotic Cells. MATERIALS (BASEL, SWITZERLAND) 2021; 14:6281. [PMID: 34771805 PMCID: PMC8585151 DOI: 10.3390/ma14216281] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
The present study a comprehensive analysis of the antibacterial properties of a composite material based on borosiloxane and zinc oxide nanoparticles (ZnO NPs). The effect of the polymer matrix and ZnO NPs on the generation of reactive oxygen species, hydroxyl radicals, and long-lived oxidized forms of biomolecules has been studied. All variants of the composites significantly inhibited the division of E. coli bacteria and caused them to detach from the substrate. It was revealed that the surfaces of a composite material based on borosiloxane and ZnO NPs do not inhibit the growth and division of mammalians cells. It is shown in the work that the positive effect of the incorporation of ZnO NPs into borosiloxane can reach 100% or more, provided that the viscoelastic properties of borosiloxane with nanoparticles are retained.
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Affiliation(s)
- Denis N. Chausov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova St. 38, 119991 Moscow, Russia; (D.N.C.); (D.E.B.); (A.D.K.); (N.F.B.); (M.E.A.); (A.V.S.); (M.V.V.)
| | - Dmitriy E. Burmistrov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova St. 38, 119991 Moscow, Russia; (D.N.C.); (D.E.B.); (A.D.K.); (N.F.B.); (M.E.A.); (A.V.S.); (M.V.V.)
| | - Alexander D. Kurilov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova St. 38, 119991 Moscow, Russia; (D.N.C.); (D.E.B.); (A.D.K.); (N.F.B.); (M.E.A.); (A.V.S.); (M.V.V.)
| | - Nikolai F. Bunkin
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova St. 38, 119991 Moscow, Russia; (D.N.C.); (D.E.B.); (A.D.K.); (N.F.B.); (M.E.A.); (A.V.S.); (M.V.V.)
- Bauman Moscow State Technical University, Vtoraya Baumanskaya ul. 5, 105005 Moscow, Russia
| | - Maxim E. Astashev
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova St. 38, 119991 Moscow, Russia; (D.N.C.); (D.E.B.); (A.D.K.); (N.F.B.); (M.E.A.); (A.V.S.); (M.V.V.)
| | - Alexander V. Simakin
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova St. 38, 119991 Moscow, Russia; (D.N.C.); (D.E.B.); (A.D.K.); (N.F.B.); (M.E.A.); (A.V.S.); (M.V.V.)
| | - Maria V. Vedunova
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova St. 38, 119991 Moscow, Russia; (D.N.C.); (D.E.B.); (A.D.K.); (N.F.B.); (M.E.A.); (A.V.S.); (M.V.V.)
- Institute of Biology and Biomedicine, Lobachevsky State, University of Nizhni Novgorod, 23 Gagarin Ave., 603950 Nizhny Novgorod, Russia
| | - Sergey V. Gudkov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilova St. 38, 119991 Moscow, Russia; (D.N.C.); (D.E.B.); (A.D.K.); (N.F.B.); (M.E.A.); (A.V.S.); (M.V.V.)
- Institute of Biology and Biomedicine, Lobachevsky State, University of Nizhni Novgorod, 23 Gagarin Ave., 603950 Nizhny Novgorod, Russia
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Abbott S, Naraen A, Rawaf D, Craik J. Should we be prepping the foot? Stockinette use and drape contamination during hip arthroplasty: An experimental study. ANZ J Surg 2021; 91:1898-1902. [PMID: 34268845 DOI: 10.1111/ans.17069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 06/23/2021] [Accepted: 07/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Meticulous prepping and draping of the surgical field is paramount to reduce the risk of infection. A consistent technique for draping for hip arthroplasty is not well established. One technique for preparing the operative field utilises a sterile stockinette over an unprepped foot. This study aims to assess surgical site contamination when draping for hip arthroplasty without disinfecting the foot. METHODS Ultraviolet (UV) fluorescent powder was used as a surrogate for microbial presence on the foot. Powder was applied to a volunteer's foot to a level where antibacterial prep would stop. The leg was then draped according to three methods; directly with stockinette only, wrapping the foot without using an adhesive seal followed by stockinette, and wrapping the foot with the adhesive seal followed by stockinette. Proximal spread of powder after draping was assessed with UV light. RESULTS Contamination of the sterile field was found with all draping methods. Spread was particularly noted in the groin, posterior to the thigh and distal to mid-thigh. Wrapping the foot in a small drape without the adhesive seal prior to stockinette application was associated with significantly greater contamination when compared with use of the seal (p = 0.004). CONCLUSION Routine formal prepping of the foot during hip arthroplasty is recommended to reduce the risk of surgical site contamination. Surgeons who select not to prep the foot should make use of a small drape with occlusive, adhesive seal prior to stockinette application and consider applying a further U drape to the hip.
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Affiliation(s)
- Sarah Abbott
- Department of Trauma and Orthopaedics, Croydon University Hospital, London, UK
| | - Akarshan Naraen
- Department of Trauma and Orthopaedics, Kingston Hospital, Kingston upon Thames, UK
| | - David Rawaf
- Department of Trauma and Orthopaedics, Kingston Hospital, Kingston upon Thames, UK
| | - Johnathan Craik
- Department of Trauma and Orthopaedics, Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
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Theil C, Schneider KN, Gosheger G, Dieckmann R, Deventer N, Hardes J, Schmidt-Braekling T, Andreou D. Does the Duration of Primary and First Revision Surgery Influence the Probability of First and Subsequent Implant Failures after Extremity Sarcoma Resection and Megaprosthetic Reconstruction? Cancers (Basel) 2021; 13:cancers13112510. [PMID: 34063771 PMCID: PMC8196552 DOI: 10.3390/cancers13112510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Tumor endoprostheses are a common type of reconstruction after the resection of an extremity bone sarcoma. However, in the long-term, first and subsequent implant failures leading to revision surgery are common. One potential risk factor for implant failure is the length of surgery. This study investigates the impact of the length of surgery on prosthetic survival in 568 patients with sarcoma. Patients who had a first implant failure had a longer surgery; however, there were no differences in the infection-free survival, but only in the probability of mechanical failure. Patients with a subsequent revision surgery for infection had a shorter duration of surgery during the first revision. In conclusion, a shorter surgery appears beneficial; however, longer surgeries are not clearly associated with infection. In revision surgery, a longer operating time, indicating a more thorough debridement, may be desirable. Abstract Complications in megaprosthetic reconstruction following sarcoma resection are quite common. While several risk factors for failure have been explored, there is a scarcity of studies investigating the effect of the duration of surgery. We performed a retrospective study of 568 sarcoma patients that underwent megaprosthetic reconstruction between 1993 and 2015. Differences in the length of surgery and implant survival were assessed with the Kaplan–Meier method, the log-rank test and multivariate Cox regressions using an optimal cut-off value determined by receiver operating curves analysis using Youden’s index. 230 patients developed a first and 112 patients a subsequent prosthetic failure. The median duration of initial surgery was 210 min. Patients who developed a first failure had a longer duration of the initial surgery (225 vs. 205 min, p = 0.0001). There were no differences in the probability of infection between patients with longer and shorter duration of initial surgery (12% vs. 13% at 5 years, p = 0.492); however, the probability of mechanical failure was higher in patients with longer initial surgery (38% vs. 23% at 5 years, p = 0.006). The median length of revision surgery for the first megaprosthetic failure was 101 min. Patients who underwent first revision for infection and did not develop a second failure had a longer median duration of the first revision surgery (150 min vs. 120 min, p = 0.016). A shorter length of the initial surgery appears beneficial, however, the notion that longer operating time increases the risk of deep infection could not be reproduced in our study. In revision surgery for infection, a longer operating time, possibly indicating a more thorough debridement, appears to be associated with a lower risk for subsequent revision.
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Affiliation(s)
- Christoph Theil
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
- Correspondence: ; Tel.: +49-2514-4278
| | - Kristian Nikolaus Schneider
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
| | - Georg Gosheger
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
| | - Ralf Dieckmann
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
- Department of Orthopedics, Krankenhaus der Barmherzigen Brueder, Nordallee 1, 54292 Trier, Germany
| | - Niklas Deventer
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
| | - Jendrik Hardes
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
- Department of Musculoskeletal Oncology, Essen University Hospital, Hufelandstraße 55, 45147 Essen, Germany
| | - Tom Schmidt-Braekling
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
- Department of Orthopedic Oncology and Sarcoma Surgery, Sarcoma Centre Berlin-Brandenburg, Helios Klinikum Bad Saarow, 15526 Bad Saarow, Germany
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Performing a Safe and Effective Total Hip Arthroplasty on Patients With Inactive or Stably Active Systemic Lupus Erythematosus With Osteonecrosis. J Am Acad Orthop Surg 2021; 29:423-432. [PMID: 32868703 DOI: 10.5435/jaaos-d-20-00464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/13/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Patients with systemic lupus erythematosus (SLE) are typically treated with total hip arthroplasty (THA) because of osteonecrosis of the femoral head (ONFH). This study evaluated the outcome of THA in this patient group. METHODS From January 2004 to January 2017, we retrospectively studied 92 THAs for patients with SLE and 92 THAs for age- and sex-matched patients suffering from ONFH due to nonrheumatic etiologies Both groups were treated with cementless THA and followed up for an average of 50.9 ± 30.6 months. Their surgical outcomes and complications were evaluated and compared. RESULTS No significant difference existed in age, sex, weight, height, follow-up time, and Ficat staging between the groups. All patients with SLE were in inactive or stably active disease conditions. For all patients, the Harris hip score (HHS) (from 52.6 to 92.8; P < 0.001), Physical Component Summary Scale score (PCS) (from 29.4 to 49.3; P < 0.001), and Mmental Component Summary Scale score (MCS) (from 50.5 to 55.5; P < 0.001) of the Short Form-12 improved significantly after surgery. At the final follow-up, the HHS and MCS were comparable between the two groups. The PCS remained lower in the SLE group (P = 0.017), and no recorded revision surgieries in either group. Corticosteroid intake and testing positive for antiphospholipid antibodies, rather than having a SLE disease activity index score greater than zero, were risk factors for higher complications. DISCUSSION Performing THA for patients with SLE in an inactive or stably active disease condition resulted in comparable postoperative HHS and MCS scores, a lower PCS score, and shorter term postoperative complications compared with patients with ONFH resulting from nonrheumatic diseases. Patients with SLE had a higher risk for postoperative complications. It is generally safe and effective to perform THA in patients with inactive or stably active SLE. However, they still have an increased risk of short-term complications.
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After Incision, the Skin Knife Blade Is No More Contaminated Than a Fresh Knife Blade. J Am Acad Orthop Surg 2021; 29:e98-e103. [PMID: 32568994 DOI: 10.5435/jaaos-d-20-00203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The rationale for discarding the skin knife blade and replacing it with another blade for deeper dissection is to prevent bacteria that may be present on the skin from being carried into the deeper layers of the wound. This practice is very controversial because numerous, yet limited, studies exist that support and refute the findings. The purpose of this study was to directly compare the rate of contamination of a skin knife blade with a control blade. METHODS We took the surface samples using Replicate Organism Detection and Counting plates of 344 knife blades immediately after making skin incision during the following four types of orthopaedic cases: total hip arthroplasty, total knee arthroplasty, lumbar spine surgery, and cervical spine surgery. At the same time, we sampled 344 control blades. The comparison of positives skin versus control, overall and within each subgroup was done using a bivariate two-sample z-test for the equality of proportions. RESULTS Overall, 35 (5.1%) of the 688 specimens had a positive result. No difference was noted in the rate of positive cultures for the 344 skin blades 4.9% and the 344 control blades 5.2%. No differences were observed in the rate of positive specimens for skin blades (7.4%, 3.4%, 7.7%, and 3.9%) and control blades (2.5%, 4.1%, 7.7%, and 9.2%) for total hip arthroplasty, total knee arthroplasty, C spine, and L spine, respectively. No differences were observed regarding skin prep, room number, case order, room turnover time, or in-room to incision time. Staphylococus species was the predominant bacteria identified. CONCLUSION We found no evidence to support the theoretical advantage of changing the knife blade after making skin incision to avoid contamination. Contamination rates were the same for both the skin and control blades overall and for all subgroup analysis.
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Justesen T, Olsen JB, Hesselvig AB, Mørup-Petersen A, Odgaard A. Does intraoperative contamination during primary knee arthroplasty affect patient-reported outcomes for patients who are uninfected 1 year after surgery? A prospective cohort study of 714 patients. Acta Orthop 2020; 91:750-755. [PMID: 32867557 PMCID: PMC8023922 DOI: 10.1080/17453674.2020.1811552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - It is well recognized that some knee arthroplasty (KA) patients present with prolonged postoperative inflammation and some develop persistent pain. It can reasonably be speculated that some of these problems develop because of low-grade infections with low virulence bacteria caused by intraoperative contamination. This prospective study was performed to investigate whether intraoperative contamination results in lower patient-reported outcomes (PRO) for patients who were clinically uninfected in the first year after surgery. Patients and methods - We combined data from 2 major prospective studies on patients undergoing primary KA at 2 Danish hospitals between September 2016 and January 2018. Pre- and postoperative (1.5, 3, 6, and 12 months) PROs and intraoperative microbiological cultures were obtained on a total of 714 patients who were included in the study. Based on the microbiological cultures, the patients were divided into 2 groups, contaminated and non-contaminated, and differences in PROs between the 2 groups were analyzed. Results - 84 of 714 (12%) patients were intraoperatively contaminated; none of the 714 patients developed clinical infection. The preoperative Oxford Knee Score was 24 and 23 for contaminated and non-contaminated patients, respectively, improving to 40 and 39 at 1 year (p = 0.8). 1-year AUC for Oxford Knee Score and absolute improvement at each postoperative time point for Forgotten Joint Score and EQ-5D-5L also were similar between contaminated and non-contaminated patients. Interpretation - Patient-reported outcomes from 714 patients do not indicate that intraoperative contamination affects the knee-specific or general health-related quality of life in primary KA patients who are clinically uninfected 1 year after surgery.
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Affiliation(s)
- Tobias Justesen
- Department of Orthopedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark,Correspondence:
| | - Jakob B Olsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - Anne B Hesselvig
- Department of Orthopedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - Anne Mørup-Petersen
- Department of Orthopedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - Anders Odgaard
- Department of Orthopedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
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Luciano RC, Macedo ÍS, Pereira RHN, Pereira DB, Luciano DV. Intraoperative graft decontamination during ACL reconstruction surgery. Rev Bras Ortop 2020; 55:410-414. [PMID: 32904805 PMCID: PMC7458738 DOI: 10.1055/s-0039-1700830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/31/2019] [Indexed: 12/03/2022] Open
Abstract
Objective
To evaluate different decontaminants for tendon grafts, proposing an antiseptic protocol for contaminated grafts.
Methods
A total of 25 patients were tissue donors for the study. Each participant donated a 2.5-cm tendon sample, which was divided into 5 fragments with 5 mm each during anterior cruciate ligament (ACL) reconstruction surgery. The collected material was divided into 5 groups, totaling 125 samples. In total, four fragments of each patient were placed on the operating room floor for one minute for contamination, simulating the fall of the graft on the floor during surgery. The other fragment was immediately placed in a sterile container (group 1). One of the contaminated fragments was placed in the sterile container without being previously immersed in decontaminating solution (group 2). The remaining fragments were immersed for ten minutes in decontaminating solution: 0.5% chlorhexidine (group 3), 0.9% saline (group 4) and 0.55% ortho-phthalaldehyde (group 5), and, after this time, they were individually placed in a sterile container. The samples from the 5 groups were submitted to microbiological examination.
Results
Bacteria were detected in 26% of the total samples in the microbiological tests, and in group 1 there was no growth of microorganisms. In group 2, bacterial growth was observed in 16 samples. Considering the evaluation of test groups 3, 4 and 5, the percentage of decontamination was higher than the growth of microorganisms in the respective cultures.
Conclusion
The protocol suggested by the study showed that intraoperative graft decontamination is possible.
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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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Cutler HS, Romero JA, Minor D, Huo MH. Sources of contamination in the operating room: A fluorescent particle powder study. Am J Infect Control 2020; 48:948-950. [PMID: 32046882 DOI: 10.1016/j.ajic.2019.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/28/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
This study utilized fluorescent particle powder to investigate 2 potential sources of sterile field contamination in the operating room (OR): forced-air warming blankets and OR light manipulation. In part 1, sterile draping for knee replacement surgery was performed on a mannequin in a sterile OR, comparing field contamination with the forced-air warming on versus off during draping. In part 2, OR lights coated with fluorescent powder were manipulated over a sterile field. Proper operation of these devices may reduce the particle burden on the surgical field.
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Does an Antimicrobial Incision Drape Prevent Intraoperative Contamination? A Randomized Controlled Trial of 1187 Patients. Clin Orthop Relat Res 2020; 478:1007-1015. [PMID: 32011378 PMCID: PMC7170680 DOI: 10.1097/corr.0000000000001142] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The risk of periprosthetic joint infection (PJI), a serious complication after arthroplasty, has not changed for years. Interventions such as eradication of Staphylococcus aureus and antibiotic bone cement are used to diminish infection risk but despite these efforts, the percentage of infection in TKA remains constant. Antimicrobial drapes have a dual action, acting both as a physical and antimicrobial barrier to counter bacterial contamination of the surgical wound. To study the effect of antimicrobial drapes, we used intraoperative contamination as a proxy for infection in our investigation. QUESTIONS/PURPOSES (1) Do antimicrobial surgical drapes reduce the risk of intraoperative microbial contamination in patients undergoing primary knee arthroplasty? (2) Are other factors such as sex, season, age, type of arthroplasty and duration of surgery associated with an increased risk of contamination in patients undergoing primary knee arthroplasty? (3) Does loosening of the antimicrobial drape increase contamination risk? METHODS An investigator-initiated, two-arm, non-blinded, multicenter, randomized, controlled trial was performed at five different hospitals in the capital and central regions of Denmark. Twenty-four surgeons participated in the study. Participants were patients older than 18 years undergoing primary knee arthroplasty. We excluded patients with an iodine allergy, previous open knee surgery, previous septic arthritis, any antibiotics taken 4 weeks before surgery, and if they were unable to understand the implications of study participation. Patients were randomly assigned to operation with an antimicrobial drape (intervention group) or operation without (control group). We screened 1769 patients, of which 100 were ineligible and 10 declined to participate. In all, 94% (1659 of 1769) of patients consented and were randomized to the intervention group (51%, 838 of 1659) and control group (49%, 821 of 1659), respectively. In all, 36% (603 of 1659) of patients in the intervention group and 35% (584 of 1659) patients in the control group were available for final analysis. No crossover was performed, and analysis was done per-protocol. Patients were excluded due to logistic failures like lack of utensils, samples disappearing en route to the laboratory mainly caused by implementation of a new electronic patient chart (EPIC, Verona, WI, USA), and forgetful surgeons. Intraoperatively, we swabbed for bacteria at the surgical site and in a rinse from the surgeons' gloves. All samples were sent for cultivation, and colony forming units (CFUs) counts ≥ 1 were deemed contaminated. The primary outcome measure was the difference in the proportion of contaminated patients between the two randomized groups. Secondary outcome measures were the affiliation of sex, season, age, type of implant used, and duration of surgery on contamination risk. To investigate whether other factors were affiliated with contamination risk, we did a logistic regression to control for confounding variables, including sex, age, season, type of implant and duration of surgery. RESULTS Use of iodinated drapes reduced contamination, with contamination detected in 10% (60 of 603) procedures where iodinated drapes were used compared with 15% (90 of 584) when they were not (odds ratio 0.61 [95% CI 0.43 to 0.87]; p = 0.005), with a relative risk reduction of 35% (95% CI 12.3 to 52.5) and a number needed to treat of 18 patients. After controlling for confounding variables such as sex, age, type of implant, and duration of surgery, we found that not using an antimicrobial drape increased contamination risk by a factor of 1.6 (95% CI 1.08 to 2.35; p = 0.02). Female sex and undergoing surgery in the central region were associated with lower odds of contamination (OR 0.55 [95% CI 0.39 to 0.8]; p = 0.002 and OR 0.45 [95% CI 0.25 to 0.8]; p = 0.006, respectively). Patients with more than a 10-mm separation of the drape from the skin had higher odds of contamination (OR 3.54 [95% CI 1.64 to 11.05]; p = 0.0013). CONCLUSIONS The use of an antimicrobial drape resulted in lower contamination risk than operating without an antimicrobial drape. Our findings suggest that antimicrobial drapes are useful in infection prevention, but further studies are needed to investigate the effect of antimicrobial drapes on infection. LEVEL OF EVIDENCE Level I, therapeutic study.
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Rattanaprichavej P, Laoruengthana A, Galassi M, Weerakul S, Rasamimongkol S. Contamination Rate of Burnt Necrotic Tissue after Electrocoagulation in Total Knee Arthroplasty. Clin Orthop Surg 2020; 12:43-48. [PMID: 32117537 PMCID: PMC7031428 DOI: 10.4055/cios.2020.12.1.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/03/2019] [Indexed: 01/22/2023] Open
Abstract
Background Periprosthetic joint infection (PJI) is one of the commonly found catastrophic complications after total knee arthroplasty (TKA). Preoperative antibiotic prophylaxis, proper skin cleansing, shortened operative time, and sterility of surgical field and equipment are essential to minimize the risk of PJI. Although bacterial contamination of electrocautery tips has been reported, contamination of residual product of electrocoagulation, burnt necrotic tissue (BNT), is not well known. Therefore, we aimed to assess the contamination rate of BNT and association between contaminated BNT and PJI, and risk factors. Methods BNTs from 183 patients who had undergone unilateral primary TKA at our institution were retrospectively analyzed. In each patient, three to five specimens of BNT were routinely collected in the operative field of primary TKA. Collecting time was defined as the duration from start of using the electrocautery device to the first collection of BNT. Results Culture was positive in eight of 183 patients (4.4%; contaminated BNT group), and the most commonly isolated organism was coagulase-negative Staphylococcus (62.5%). The average operative time was 103.1 ± 44.2 minutes in the contaminated BNT group and 79.0 ± 16.7 minutes in the non-contaminated BNT group (p = 0.17), and collecting time was 48.0 ± 44.3 minutes and 29.7 ± 17.0 minutes (p = 0.28), respectively. None of the patients with contaminated BNT developed PJI, whereas four patients with culture-negative BNT developed PJI within 2 postoperative years. Conclusions BNT in surgical field can become a reservoir of contaminating bacteria. However, contamination of BNT was not associated with PJI. Therefore, routine removal of all BNTs may be unnecessary.
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Affiliation(s)
- Piti Rattanaprichavej
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Monton Galassi
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Santi Weerakul
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Supachok Rasamimongkol
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
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Abstract
The use of shoulder arthroplasty is continuing to expand. Periprosthetic joint infection of the shoulder is a devastating complication occurring in approximately 1% of cases. The most common organisms responsible for the infection are Cutibacterium acnes (formerly Propionibacterium acnes) (∼39%) and coagulase-negative Staphylococcus (∼29%). Evaluation of patients includes history and physical examination, serologic testing, imaging, possible joint aspiration, and tissue culture. Diagnosing infections caused by lower virulence organisms (eg, C acnes) poses a challenge to the surgeon because traditional diagnostic tests (erythrocyte sedimentation rate, C-reactive protein, and joint aspiration) have a low sensitivity due to the lack of an inflammatory response. Periprosthetic joint infections of the shoulder due to Staphylococcus aureus and other highly virulent organisms are often easy to diagnose and are usually treated with two-stage revisions. However, for infections with C acnes and coagulase-negative Staphylococcus, single- and two-stage revision surgeries have shown similar ability to clear the infection. Unexpected positive cultures for C acnes during revision surgery are not uncommon; the proper management is still under investigation and remains a challenge.
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Renard G, Laffosse JM, Tibbo M, Lucena T, Cavaignac E, Rouvillain JL, Chiron P, Severyns M, Reina N. Periprosthetic joint infection in aseptic total hip arthroplasty revision. INTERNATIONAL ORTHOPAEDICS 2019; 44:735-741. [PMID: 31240360 DOI: 10.1007/s00264-019-04366-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 06/17/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE There is no consensus regarding systematic screening for infection in aseptic revision total hip arthroplasty (THA). The rationale for systematic intra-operative samples is to increase the sensitivity of latent infections detection, which may require specific treatment. However, the incidence of occult infection in revision THAs is not precisely known. As such, the aim of the study was to evaluate the incidence of occult infection in presumed aseptic revision THAs and identify associated risk factors. METHOD Bacteriological samples from 523 aseptic THA revisions performed for five years were analyzed. Revisions performed for periprosthetic joint infection (PJI) or clinical suspicion of PJI were excluded. Microbiological cultures were performed using tissue samples in 505 cases (97%), synovial fluid in blood culture vials in 158 (30%), and in dry tubes in 263 (50%). Implants were sent for sonication in 12 cases (2.6%). The mean number of microbiological samples per patient was 3.6 (range, 1-15). Histology samples were collected for 300 patients (57%). RESULTS The incidence of occult infection was 7% (36 cases) and contamination 8% (42 cases). Among occult infections, the primary reasons for revision were dislocation (42%), aseptic loosening (25%), fracture (19%), and others (14%). The infection rate in the dislocation group was significantly higher than that of other reasons for revision (p < 0.001). Among the patients determined with PJI, the revision THA was performed less than a year after primary in 19 (53%). CONCLUSION The incidence of occult PJI justifies systematic intraoperative sampling. A short time between primary arthroplasty and revision or an early postoperative dislocation is a factor to suspect infections.
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Affiliation(s)
- Guillaume Renard
- ILM Institut Locomoteur, Hôpital Pierre-Paul-Riquet, CHU de Toulouse, 31059, Toulouse, France.,Département de Chirurgie Orthopédique, Hôpital Pierre Zobda-Quitman, CHU de Martinique, 97261, Fort-de-France, France
| | - Jean-Michel Laffosse
- ILM Institut Locomoteur, Hôpital Pierre-Paul-Riquet, CHU de Toulouse, 31059, Toulouse, France
| | - Meagan Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
| | - Thibault Lucena
- ILM Institut Locomoteur, Hôpital Pierre-Paul-Riquet, CHU de Toulouse, 31059, Toulouse, France
| | - Etienne Cavaignac
- ILM Institut Locomoteur, Hôpital Pierre-Paul-Riquet, CHU de Toulouse, 31059, Toulouse, France
| | - Jean-Louis Rouvillain
- Département de Chirurgie Orthopédique, Hôpital Pierre Zobda-Quitman, CHU de Martinique, 97261, Fort-de-France, France
| | - Philippe Chiron
- ILM Institut Locomoteur, Hôpital Pierre-Paul-Riquet, CHU de Toulouse, 31059, Toulouse, France
| | - Mathieu Severyns
- Département de Chirurgie Orthopédique, Hôpital Pierre Zobda-Quitman, CHU de Martinique, 97261, Fort-de-France, France.
| | - Nicolas Reina
- ILM Institut Locomoteur, Hôpital Pierre-Paul-Riquet, CHU de Toulouse, 31059, Toulouse, France
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Rate of surface contamination in the operating suite during revision total joint arthroplasty. Arthroplast Today 2019; 5:96-99. [PMID: 31020031 PMCID: PMC6475652 DOI: 10.1016/j.artd.2018.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 11/24/2022] Open
Abstract
Background This study estimated operating room surface contamination rates during aseptic vs septic total joint arthroplasty and evaluated the similarity between clinically infecting organisms and those isolated from contaminated surfaces. Methods Patients undergoing total hip and knee revision arthroplasties were identified, and surface and tissue samples were collected. Cases were classified aseptic or septic based on Musculoskeletal Infection Society criteria for prosthetic joint infection. Positive surface cultures were compared with intraoperative tissue cultures. Positive cultures were speciated and tested for antimicrobial sensitivity. Results Samples were collected from 31 aseptic and 18 septic cases. Patients had similar demographics and time to explantation. Surface contamination rates for septic revisions were greater than those for aseptic revisions (77% vs 13%). During septic revisions, when intraoperative tissue cultures were positive, the surgical field was contaminated in 14 of 15 cases. The kappa correlation statistic for positive surgical cultures matching the surface sample was 0.9 (95% confidence interval: 0.78-1). Conclusions Septic revisions had a significantly higher rate of surgical field contamination than aseptic revisions. Cultures suggest that bacteria contaminating the septic revision surgical field likely originated from the infected joint. Although this observation seems obvious, it is an important piece of information when discussing best practices during a single-stage exchange revision. Further clinical studies will demonstrate the use of a preparation and reset period during a single-stage revision to remove contaminated surfaces.
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Hohmann E. Editorial Commentary: Bacterial Load and Contamination of Anterior Cruciate Ligament Grafts-Overamplified Dreadful Nuclear Assumption (DNA) or Underestimated Problem? Arthroscopy 2018; 34:3053-3054. [PMID: 30392689 DOI: 10.1016/j.arthro.2018.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 07/10/2018] [Indexed: 02/02/2023]
Abstract
Bacterial DNA is present in a large percentage in failed anterior cruciate ligament reconstructions. A potential concern is the presence of biofilm on both failed anterior cruciate ligament reconstruction grafts and suture material. Despite the high prevalence of bacterial material observed, microbial cultures are rarely positive. However, it is currently unknown whether these findings have any clinical implications.
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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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Environment of care: Is it time to reassess microbial contamination of the operating room air as a risk factor for surgical site infection in total joint arthroplasty? Am J Infect Control 2017; 45:1267-1272. [PMID: 28818359 DOI: 10.1016/j.ajic.2017.06.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 06/23/2017] [Accepted: 06/24/2017] [Indexed: 11/22/2022]
Abstract
In the modern operating room (OR), traditional surgical mask, frequent air exchanges, and architectural barriers are viewed as effective in reducing airborne microbial populations. Intraoperative sampling of airborne particulates is rarely performed in the OR because of technical difficulties associated with sampling methodologies and a common belief that airborne contamination is infrequently associated with surgical site infections (SSIs). Recent studies suggest that viable airborne particulates are readily disseminated throughout the OR, placing patients at risk for postoperative SSI. In 2017, virtually all surgical disciplines are engaged in the implantation of selective biomedical devices, and these implants have been documented to be at high risk for intraoperative contamination. Approximately 1.2 million arthroplasties are performed annually in the United States, and that number is expected to increase to 3.8 million by the year 2030. The incidence of periprosthetic joint infection is perceived to be low (<2.5%); however, the personal and fiscal morbidity is significant. Although the pharmaceutic and computer industries enforce stringent air quality standards on their manufacturing processes, there is currently no U.S. standard for acceptable air quality within the OR environment. This review documents the contribution of air contamination to the etiology of periprosthetic joint infection, and evidence for selective innovative strategies to reduce the risk of intraoperative microbial aerosols.
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Narita K, Asano K, Morimoto Y, Igarashi T, Hamblin MR, Dai T, Nakane A. Disinfection and healing effects of 222-nm UVC light on methicillin-resistant Staphylococcus aureus infection in mouse wounds. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 178:10-18. [PMID: 29101868 DOI: 10.1016/j.jphotobiol.2017.10.030] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/12/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022]
Abstract
UVC radiation is known to be highly germicidal. However, exposure to 254-nm-UVC light causes DNA lesions such as cyclobutane pyrimidine dimers (CPD) in human cells, and can induce skin cancer after long-term repeated exposures. It has been reported that short wavelength UVC is absorbed by proteins in the membrane and cytosol, and fails to reach the nucleus of human cells. Hence, irradiation with 222-nm UVC might be an optimum combination of effective disinfection and biological safety to human cells. In this study, the biological effectiveness of 222-nm UVC was investigated using a mouse model of a skin wound infected with methicillin-resistant Staphylococcus aureus (MRSA). Irradiation with 222-nm UVC significantly reduced bacterial numbers on the skin surface compared with non-irradiated skin. Bacterial counts in wounds evaluated on days 3, 5, 8 and 12 after irradiation demonstrated that the bactericidal effect of 222-nm UVC was equal to or more effective than 254-nm UVC. Histological analysis revealed that migration of keratinocytes which is essential for the wound healing process was impaired in wounds irradiated with 254-nm UVC, but was unaffected in 222-nm UVC irradiated wounds. No CPD-expressing cells were detected in either epidermis or dermis of wounds irradiated with 222-nm UVC, whereas CPD-expressing cells were found in both epidermis and dermis irradiation with 254-nm UVC. These results suggest that 222-nm UVC light may be a safe and effective way to reduce the rate of surgical site and other wound infections.
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Affiliation(s)
- Kouji Narita
- Department of Microbiology and Immunology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan; Institute for Animal Experimentation, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Krisana Asano
- Department of Microbiology and Immunology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan; Department of Biopolymer and Health Science, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | | | | | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tianhong Dai
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Akio Nakane
- Department of Microbiology and Immunology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan; Department of Biopolymer and Health Science, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
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Deer TR, Provenzano DA, Hanes M, Pope JE, Thomson SJ, Russo MA, McJunkin T, Saulino M, Raso LJ, Lad SP, Narouze S, Falowski SM, Levy RM, Baranidharan G, Golovac S, Demesmin D, Witt WO, Simpson B, Krames E, Mekhail N. The Neurostimulation Appropriateness Consensus Committee (NACC) Recommendations for Infection Prevention and Management. Neuromodulation 2017; 20:31-50. [PMID: 28042909 DOI: 10.1111/ner.12565] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/13/2016] [Accepted: 10/24/2016] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The use of neurostimulation for pain has been an established therapy for many decades and is a major tool in the arsenal to treat neuropathic pain syndromes. Level I evidence has recently been presented to substantiate the therapy, but this is balanced against the risk of complications of an interventional technique. METHODS The Neurostimulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society convened an international panel of well published and diverse physicians to examine the best practices for infection mitigation and management in patients undergoing neurostimulation. The NACC recommendations are based on evidence scoring and peer-reviewed literature. Where evidence is lacking the panel added expert opinion to establish recommendations. RESULTS The NACC has made recommendations to improve care by reducing infection and managing this complication when it occurs. These evidence-based recommendations should be considered best practices in the clinical implantation of neurostimulation devices. CONCLUSION Adhering to established standards can improve patient care and reduce the morbidity and mortality of infectious complications in patients receiving neurostimulation.
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Affiliation(s)
| | | | | | | | - Simon J Thomson
- Pain Management and Neuromodulation Centre, Basildon & Thurrock University Hospitals, NHS, Trust, UK
| | | | | | | | | | - Shivanand P Lad
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Samer Narouze
- Summa Western Reserve Hospital, Cuyahoga Falls, OH, USA
| | | | | | | | | | - Didier Demesmin
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William O Witt
- Cardinal Hill Pain Institute (emeritus), Lexington, KY, USA
| | - Brian Simpson
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Elliot Krames
- Pacific Pain Treatment Center (ret.), San Francisco, CA, USA
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Thomas MB, Metoki N, Mandler D, Eliaz N. In Situ Potentiostatic Deposition of Calcium Phosphate with Gentamicin-Loaded Chitosan Nanoparticles on Titanium Alloy Surfaces. Electrochim Acta 2016. [DOI: 10.1016/j.electacta.2016.10.186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pinder EM, Bottle A, Aylin P, Loeffler MD. Does laminar flow ventilation reduce the rate of infection? Bone Joint J 2016; 98-B:1262-9. [DOI: 10.1302/0301-620x.98b9.37184] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 05/05/2016] [Indexed: 11/05/2022]
Abstract
Aims To determine whether there is any difference in infection rate at 90 days between trauma operations performed in laminar flow and plenum ventilation, and whether infection risk is altered following the installation of laminar flow (LF). Patients and Methods We assessed the impact of plenum ventilation (PV) and LF on the rate of infection for patients undergoing orthopaedic trauma operations. All NHS hospitals in England with a trauma theatre(s) were contacted to identify the ventilation system which was used between April 2008 and March 2013 in the following categories: always LF, never LF, installed LF during study period (subdivided: before, during and after installation) and unknown. For each operation, age, gender, comorbidity, socio-economic deprivation, number of previous trauma operations and surgical site infection within 90 days (SSI90) were extracted from England’s national hospital administrative Hospital Episode Statistics database. Crude and adjusted odds ratios (OR) were used to compare ventilation groups using hierarchical logistic regression. Subanalysis was performed for hip hemiarthroplasties. Results A total of 803 065 trauma operations were performed during this time; 19 hospitals installed LF, 124 already had LF, 13 had PV and the type of ventilation was unknown in 28. Patient characteristics were similar between the groups. The rate of SSI90 was similar for always LF and PV (2.7% and 2.4%). For hemiarthroplasties of the hip, the rates of SSI90 were significantly higher for LF compared with PV (3.8% and 2.6%, OR 1.45, p = 0·001). Hospitals installing LF did not see any statistically significant change in the rate of SSI90. Conclusion The results of this observational study imply that infection rate is similar when orthopaedic trauma surgery is performed in LF and PV, and is unchanged by installing LF in a previously PV theatre. Cite this article: Bone Joint J 2016;98-B:1262–9.
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Affiliation(s)
- E. M. Pinder
- Colchester General Hospital, Turner
Road, Colchester CO4 5JL, UK
| | - A. Bottle
- Dr Foster Unit at ImperialCollege London, 3
Dorset Rise, London EC4Y 8EN, UK
| | - P. Aylin
- Dr Foster Unit at ImperialCollege London, 3
Dorset Rise, London EC4Y 8EN, UK
| | - M. D. Loeffler
- Colchester General Hospital, Turner
Road, Colchester CO4 5JL, UK
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Pereira LC, Kerr J, Jolles BM. Intra-articular steroid injection for osteoarthritis of the hip prior to total hip arthroplasty. Bone Joint J 2016; 98-B:1027-35. [DOI: 10.1302/0301-620x.98b8.37420] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/10/2016] [Indexed: 11/05/2022]
Abstract
Aims Using a systematic review, we investigated whether there is an increased risk of post-operative infection in patients who have received an intra-articular corticosteroid injection to the hip for osteoarthritis prior to total hip arthroplasty (THA). Methods Studies dealing with an intra-articular corticosteroid injection to the hip and infection following subsequent THA were identified from databases for the period between 1990 to 2013. Retrieved articles were independently assessed for their methodological quality. Results A total of nine studies met the inclusion criteria. Two recommended against a steroid injection prior to THA and seven found no risk with an injection. No prospective controlled trials were identified. Most studies were retrospective. Lack of information about the methodology was a consistent flaw. Conclusions The literature in this area is scarce and the evidence is weak. Most studies were retrospective, and confounding factors were poorly defined or not addressed. There is thus currently insufficient evidence to conclude that an intra-articular corticosteroid injection administered prior to THA increases the rate of infection. High quality, multicentre randomised trials are needed to address this issue. Cite this article: Bone Joint J 2016;98-B:1027–35.
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Affiliation(s)
- L. C. Pereira
- Centre Hospitalier Universitaire Vaudois, Site
Hôpital Orthopédique, Avenue Pierre Decker
4, CH-1011 Lausanne, Switzerland
| | - J. Kerr
- Therap-ease Treatment Centre, 382
Morningside Road, Edinburgh, EH10
5HX, UK
| | - B. M. Jolles
- Centre Hospitalier Universitaire Vaudois, Site
Hôpital Orthopédique, Avenue Pierre Decker
4, CH-1011 Lausanne, Switzerland
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Trikha V, Saini P, Mathur P, Agarwal A, Kumar SV, Choudhary B. Single versus double blade technique for skin incision and deep dissection in surgery for closed fracture: a prospective randomised control study. J Orthop Surg (Hong Kong) 2016; 24:67-71. [PMID: 27122516 DOI: 10.1177/230949901602400116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare blade cultures in surgery for closed fracture using a single or double blade technique to determine whether the current practice of double blade technique is justified. METHODS 155 men and 29 women aged 20 to 60 (mean, 35) years who underwent surgery for closed fracture with healthy skin at the incision site were included. Patients were block randomised to the single (n=92) or double (n=92) blade technique. Blades were sent for bacteriological analysis. Outcome measures were early surgical site infection (SSI) within 30 days and cultures from the blades. RESULTS The 2 groups were comparable in baseline characteristics. In the single blade group, 6 surgical blades and 2 control blades showed positive cultures; 4 patients developed SSI, but only one had a positive culture from the surgical blade (with different organism isolated from the wound culture). In the double blade group, 6 skin blades, 7 deep blades, and 0 control blade showed positive culture; only 2 patients had the same bacteria grown from both skin and deep blade. Five patients developed SSI, but only one patient had a positive culture from the deep blade (with different organism isolated from the wound culture). The difference in incidence of culture-positive blade or SSI between the 2 groups was not significant. The relative risk of SSI in the single blade group was 0.8. Positive blade culture was not associated with SSI in the single or double blade group. CONCLUSION The practice of changing blade following skin incision has no effect on reducing early SSI in surgery for closed fracture in healthy patients with healthy skin.
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Affiliation(s)
- V Trikha
- Department of Orthopaedics, JPNATC, AIIMS, New Delhi, India
| | - P Saini
- Department of Spine Surgery, PD Hinduja Hospital & MRC, Mahim, Mumbai, India
| | - P Mathur
- Department of Microbiology, JPNATC, AIIMS, New Delhi, India
| | - A Agarwal
- Department of Orthopaedics, JPNATC, AIIMS, New Delhi, India
| | - S V Kumar
- Department of Orthopaedics, JPNATC, AIIMS, New Delhi, India
| | - B Choudhary
- Department of Orthopaedics, JPNATC, AIIMS, New Delhi, India
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Creech CL, Malan JR, Meyr AJ. Evaluation of the Sagittal Saw Blade as an Intraoperative Fomite During Diabetic Foot Surgery. Foot Ankle Spec 2015; 8:279-83. [PMID: 25428180 DOI: 10.1177/1938640014560162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Surgical site infection is a major potential complication of all operative interventions, and the diabetic foot is particularly at risk for bacterial recontamination and infectious sequelae. The objective of this study was to identify whether the sagittal saw blade used during partial foot amputations and diabetic foot debridements carries the potential to serve as a bacterial fomite. We physically cultured the sagittal saw blade during 20 foot debridements involving the resection of bone in patients diagnosed with a diabetic foot infection. The culture was taken after the initial debridement and during the irrigation phase of the procedure. We observed 16 positive routine intraoperative culture results, with positive saw blade culture results in 15 (93.8%; 15/16) of these cases. In 14 (93.3%; 14/15) of these cases, the saw blade culture grew at least one of the same bacteria as our other routine intraoperative cultures. We observed 4 negative routine intraoperative culture results, with negative saw blade culture results in 3 (75.0%; 3/4) of these cases. This results in agreement between routine intraoperative cultures and saw blade culture of 85.0% (17/20). The results of this investigation demonstrate that the sagittal saw blade used for osseous resection during diabetic foot debridements and partial foot amputations carries the potential for intraoperative bacterial transmission. We recommend changing at least the sagittal saw blade if more bone is resected following irrigation, particularly if it is used to obtain a "clean margin" for microbiological or histological examination. LEVELS OF EVIDENCE Therapeutic, Level IV: Case series.
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Affiliation(s)
- Corine L Creech
- Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, Pennsylvania (CLC)Podiatric Surgical Residency Program, St Luke's Allentown Hospital, Allentown, Pennsylvania (JM)Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania (AJM)
| | - Jared R Malan
- Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, Pennsylvania (CLC)Podiatric Surgical Residency Program, St Luke's Allentown Hospital, Allentown, Pennsylvania (JM)Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania (AJM)
| | - Andrew J Meyr
- Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, Pennsylvania (CLC)Podiatric Surgical Residency Program, St Luke's Allentown Hospital, Allentown, Pennsylvania (JM)Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania (AJM)
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Yaldiz C, Yaldiz M, Ceylan N, Kacira OK, Ceylan D, Kacira T, Kizilcay G, Tanriverdi T. Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization. Medicine (Baltimore) 2015; 94:e1177. [PMID: 26200620 PMCID: PMC4602987 DOI: 10.1097/md.0000000000001177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.
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Affiliation(s)
- Can Yaldiz
- From the Departmant of Neurosurgery (CY, DC, TK, GK); Departmant of Dermatology (MY); Departmant of Internal Medicine (NC); Departmant of Radiology (OKK), Sakarya University Training and Research Hospital, Sakarya; and Department of Neurosurgery (TT), Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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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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Abstract
OBJECTIVE Experiments were performed to determine the risk of bacterial contamination associated with changing outer gloves and using disposable spunlace paper versus reusable cloth gowns. BACKGROUND Despite decades of research, there remains a lack of consensus regarding certain aspects of optimal aseptic technique including outer glove exchange while double-gloving and surgical gown type selection. METHODS In an initial glove study, 102 surgical team members were randomized to exchange or retain outer gloves 1 hour into clean orthopedic procedures; cultures were obtained 15 minutes later from the palm of the surgeon's dominant gloved hand and from the surgical gown sleeve. Surgical gown type selection was recorded. A laboratory strike-through study investigating bacterial transmission through cloth and paper gowns was performed with coagulase-negative staphylococci. In a follow-up glove study, 251 surgical team members, all wearing paper gowns, were randomized as in the first glove study. RESULTS Glove study 1 revealed 4-fold higher levels of baseline bacterial contamination (31% vs 7%) on the sleeve of surgical team members wearing cloth gowns than those using paper gowns [odds ratio (95% confidence interval): 4.64 (1.72-12.53); P = 0.0016]. The bacterial strike-through study revealed that 26 of 27 cloth gowns allowed bacterial transmission through the material compared with 0 of 27 paper gowns (P < 0.001). In glove study 2, surgeons retaining outer gloves 1 hour into the case had a subsequent positive glove contamination rate of 23% compared with 13% among surgeons exchanging their original outer glove [odds ratio (95% confidence interval): 1.97 (1.02-3.80); P = 0.0419]. CONCLUSIONS Paper gowns demonstrated less bacterial transmission in the laboratory and lower rates of contamination in the operating room. Disposable paper gowns are recommended for all surgical cases, especially those involving implants, because of the heightened risk of infection. Outer glove exchange just before handling implant materials is also recommended to minimize intraoperative contamination.
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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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Abstract
STUDY DESIGN A prospective microbiological analysis of intervertebral disk material in surgically treated patients presenting lumbar disk degeneration. OBJECTIVE To determine the prevalence and species of bacteria in degenerated lumbar disks, their eventual role in the pathophysiology, and the possible influence of risk factors. SUMMARY OF BACKGROUND DATA Intervertebral disk degeneration results from biochemical, mechanical, genetic, and toxic factors. The hypothesis of low-grade infection has been raised but not elucidated to date. METHODS Eighty-three patients (34 males, 49 females, 41 y) were treated by lumbar disk replacement at L3-L4, L4-L5, or L5-S1. An intraoperative biopsy and microbiological culture were performed for each disk to determine if intradiskal bacteria were present. Magnetic resonance stages were Pfirrmann IV or V, with Modic I in 32, and Modic II in 25 cases. A preoperative discography was performed in 49 patients, 24 had previous nucleotomy. RESULTS Bacteria were found in 40 disks, 43 cultures were sterile. The following bacteria were evidenced: Propionibacterium acnes 18, coagulase-negative staphylococci 16, gram-negative bacilli 3, Micrococcus 3, Corynebacterium 3, others 5. Ten biopsies presented 2 different species. Multinucleated cells were evidenced histologically in 33% of positive biopsies. Bacteria were predominantly found in males (P=0.012). The mostly positive level was L4-L5 (P=0.075). There was no significant relationship between bacterial evidence and Modic sign. A preoperative discography or previous nucleotomy did not represent significant contamination sources. None of the patients presented infectious symptoms. CONCLUSIONS Although the hypothesis of biopsy contamination cannot be excluded, intradiskal bacteria might play a role in the pathophysiology of disk degeneration. However, the histologic presence of multinucleated cells may indicate an inflammatory process that could sustain the hypothesis of low-grade spondylodiscitis at 1 stage of the cascade of lumbar disk degeneration. These microbiological and histologic findings would need to be compared with nondegenerated disks. LEVEL OF EVIDENCE : Diagnostic level III.
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Butt U, Saleem U, Yousuf K, El-Bouni T, Chambler A, Eid AS. Infection risk from surgeons' eyeglasses. J Orthop Surg (Hong Kong) 2012; 20:75-7. [PMID: 22535816 DOI: 10.1177/230949901202000115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To assess bacterial contamination of 20 eyeglasses from surgeons. METHODS 40 samples were taken from the nose pad (n=20) and earpiece (n=20) of 20 eyeglasses from orthopaedic surgeons using a sterile swab stick soaked in sterile distilled water. Swabs were incubated and inoculated onto 3 plates: Staphylococcus/Streptococcus agar plate, Mannitol salt plate, and Chromogenic agar plate. Organisms isolated were identified. RESULTS Of 20 eyeglasses, 19 were contaminated with Staphylococcus epidermidis (3 of them additionally grew S haemolyticus or S xylosus) and the remaining one grew S aureus . CONCLUSION Eyeglasses are a source of surgical infection. Contamination can be caused by direct contact of the eyeglasses to the wound and indirect contact by the surgeon's fingers, splashes from saline irrigation, and through air. Therefore, disinfection should be performed for eyeglasses of surgeons. The use of surgical visor masks or filtered exhaust helmets (space suits) are alternatives.
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Affiliation(s)
- Umer Butt
- Department of Orthopaedic Surgery, Yeovil Hospital, Somerset, United Kingdom
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Singh VK, Hussain S, Javed S, Singh I, Mulla R, Kalairajah Y. Sterile surgical helmet system in elective total hip and knee arthroplasty. J Orthop Surg (Hong Kong) 2011; 19:234-7. [PMID: 21857053 DOI: 10.1177/230949901101900222] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the sterility of the sterile surgical helmet system (SSHS) during elective total hip and knee arthroplasty in theatres with (n=20) and without (n=20) laminar flow. METHODS Three surgeons performed 14 total knee arthroplasties (TKAs) and 6 total hip arthroplasties (THAs) in a laminar flow theatre and 15 TKAs and 5 THAs in a non-laminar flow theatre. An SSHS was used in all the procedures. Samples were taken from the hood at 30-minute intervals during surgery. Swabs were then broken into cooked meat broths for cultivation of organisms. The broths were then directly inoculated onto blood agar and fastidious anaerobic agar for culture of aerobic and anaerobic bacteria, respectively. After 24 hours, these plates were reinoculated with broths that had been incubated for 24 hours. Microbial growth was quantified as 0 (none), 1 (mild), 2 (moderate) and 3 (heavy). Bacterial contamination in the 2 groups at 30, 60 and 90 minutes was compared. RESULTS Respectively in the laminar and non-laminar flow theatres, 0 and 9 of the SSHSs showed bacterial growth after direct inoculation, and 14 and 18 of the SSHSs grew 18 and 24 types of organisms in the swab cultures after 24 hours of incubation. Respectively at 30, 60, and 90 minutes, the degree of contamination from direct incubation was significant, but the degree of contamination on swabs after 24 hours of inoculation was not significant. The mean time-dependent contamination after direct inoculation was 0 for the laminar flow group and 0.5, 0.75, and 1.0 for the non-laminar flow group, whereas the corresponding values after 24 hours of incubation were 1.8, 1.8, and 2.6, and 2, 2.75, and 2.95. Coagulase negative Staphylococcus aureus was the most common organism in both groups. CONCLUSION 80% of SSHSs used were contaminated intra-operatively. Direct contact with the SSHS should be avoided by the operating team during surgery. Routine changing of gloves in case of contact with the SSHS should be practised.
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Affiliation(s)
- Vinay Kumar Singh
- Department of Trauma and Orthopaedics, Epsom and St. Helier Hospital, Carshalton, United Kingdom.
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