Contamination rate of the surgical gowns during total hip arthroplasty

Klaber, Ianiv; Ruíz, Pablo; Schweitzer, Daniel; Lira, María Jesús; Botello, Eduardo; Wozniak, Aniela

doi:10.1007/s00402-019-03211-w

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…A sterile surgical helmet system also is not absolutely reliable in terms of preventing contamination [131,132]. In fact, sterile surgical gloves and gowns can be contaminated during longer procedures [133][134][135], and double gloving is recommended in TJA surgery to eliminate contamination of the operating site [136]. Many surgeons change gloves several times per surgery, depending on the operating time or phases of surgery.…”

Section: Team Personnelmentioning

confidence: 99%

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

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A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.

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Section: Team Personnelmentioning

confidence: 99%

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

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“…31 vs. 7% baseline bacterial contamination in cloth gowns vs. paper gowns 2. 23% of surgeons retaining outer gloves had positive glove contamination vs. 13% of those exchanging gloves Recommendation for disposable paper gowns and outer glove exchange just before handling implant materials Klaber et al (2019) [ 21 ] Surgical gowns 140 surgical gowns Bacterial contamination in 12% of surgical gowns (4% in total hip arthroplasty vs. 22% in spine and knee surgery) Higher surgical gown contamination during non-arthroplasty procedures Wichmann et al (2019) [ 22 ] Surgical gloves 43 pairs of knitted cotton outer gloves 9% of gloves yielded > 100 CFU under aerobic conditions, 14% under anaerobic conditions Low microbial contamination of knitted cotton outer gloves, but relevant proportion showing contamination above minimal thresholds Amirfeyz et al (2007) [ 23 ] Theatre shoes 50 outside shoes, 50 theatre shoes morning and 50 end of day Microbial growth in 90% of outside shoes, 68% of theatre shows in the morning, and 56% of theatre shoes end-of-day Recommendation for dedicated theatre shoe use and good floor washing protocol Implant exposure to air Bible et al (2013) [ 24 ] Coverage of implants 105 surgical trays (54 uncovered vs. 51 covered trays) Overall 10% contamination with 2% of covered vs. 17% of uncovered implants Coverage of implants significantly reduces their contamination Dalstrom et al (2008) [ 25 ] Coverage of implants 45 surgical trays (15 uncovered and no traffic, 15 uncovered and traffic, 15 covered) Microbial growth in 4% at 30 min to 30% at 4 h of uncovered trays vs. 0% in covered trays Coverage of implants significantly reduces their contamination; microbial growth correlated with the duration of open exposure Menekse et al (2015) [ 26 ] Coverage of implants 42 surgical trays (20 uncovered vs. 22 covered) Microbial growth in 55% vs. 18% in uncovered and covered trays, respectively, after 120 min Coverage of implants significantly reduces their contamination; microbial growth correlated with the duration of open exposure Uzun et al (2019) [ 27 ] Coverage of implants 60 surgical trays (30 uncovered vs. 30 covered) Statistically significant difference in contamination at all time points Coverage of implants significantly reduces t...…”

Section: Resultsmentioning

confidence: 99%

“…Multiple studies recommend the use of disposable paper gowns due to a higher permeability of bacteria and thus a higher contamination rate in reusable gowns [19,20]. Despite these recommendations, in 2019 Klaber et al still found a bacterial contamination rate of 12% in 140 surgical gowns in different orthopaedic surgeries, ranging from 4.1% in hip surgery to 21.7% in spine and knee surgery [21].…”

Section: Intraoperative Sources Of Implant Contaminationmentioning

confidence: 99%

Implant contamination as a cause of surgical site infection in spinal surgery: are single-use implants a reasonable solution? – a systematic review

Schömig

Perka

Pumberger

et al. 2020

BMC Musculoskelet Disord

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Background In spine surgery, surgical site infection (SSI) is one of the main perioperative complications and is associated with a higher patient morbidity and longer patient hospitalization. Most factors associated with SSI are connected with asepsis during the surgical procedure and thus with contamination of implants and instruments used which can be caused by pre- and intraoperative factors. In this systematic review we evaluate the current literature on these causes and discuss possible solutions to avoid implant and instrument contamination. Methods A systematic literature search of PubMed addressing implant, instrument and tray contamination in orthopaedic and spinal surgery from 2001 to 2019 was conducted following the PRISMA guidelines. All studies regarding implant and instrument contamination in orthopaedic surgery published in English language were included. Results Thirty-five studies were eligible for inclusion and were divided into pre- and intraoperative causes for implant and instrument contamination. Multiple studies showed that reprocessing of medical devices for surgery may be insufficient and lead to surgical site contamination. Regarding intraoperative causes, contamination of gloves and gowns as well as contamination via air are the most striking factors contributing to microbial contamination. Conclusions Our systematic literature review shows that multiple factors can lead to instrument or implant contamination. Intraoperative causes of contamination can be avoided by implementing behavior such as changing gloves right before handling an implant and reducing the instruments’ intraoperative exposure to air. In avoidance of preoperative contamination, there still is a lack of convincing evidence for the use of single-use implants in orthopaedic surgery.

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“…Surgical gown contamination is a critical issue that could lead to surgical site infection, and cause the failure of the surgery. If the gown slipping down somewhat, the key sterile part will not be maintained, and it would possibly lead to an increased infection rate [10][11][12]. Surgical gowns made of slippery materials have the tendency to slip down due to gravity and physical movements as they are being worn.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Combined Tie-Fastening Method for the Reusable Surgical Gown with Two Neck Tie Belts to Improve Wearing Comfort

2020

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The reusable surgical gowns made of slippery materials have the tendency to slip down as they are being worn. The rear neck tie(s) can sometimes loosen, and this causes the surgical gown to slip down somewhat, making the surgical staff members feel uncomfortable. If the gowns have two rear neck ties with a tendency of loosening and allowing the gowns to slip down, the surgical staff members feel more uncomfortable when there is only one tie loosening but the other tie is tethering. To fasten the neck ties of the surgical gown with two neck tie belts, we propose a simplified method of fastening the two sets of tie belts together as one tie, instead of fastening them separately. The object of this study is to evaluate this combined tying method for its ability to secure the gown and its wearing comfort. We enrolled five volunteers to evaluate the tie loosening condition of the reusable surgical gowns with two sets of rear neck tie belts after a series of upper limb motion exercises while wearing and not wearing the X-ray protective apron beneath the gown. The amount of uppermost rear neck cloth edge separation was recorded before and after the exercise. We also evaluated the wearing comfort of five enrolled operating surgeons for comparing the original and this modified tying method while wearing and not wearing the X-ray protective apron. In the results, we found that combined tying tends to have significantly more rear gown separation (0.94 cm) than separate tying (0.27 cm) after vigorous upper extremities exercise. However, during the actual performance of the surgeries, the rear neck tie(s) loosening and wearing discomfort of the combined tying method was significantly less than using the separate tying method (loosening: 0% vs. 30%) (discomfort: 0% vs. 35%) while the X-ray protective apron was not worn. For reusable surgical gowns that have two rear neck ties, we suggest the two sets of rear neck ties could be fastened together as one combined tie in routine surgical practice. With this, tying could be performed easier and faster, and wearing comfort could be improved.

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Contamination rate of the surgical gowns during total hip arthroplasty

Cited by 6 publications

References 15 publications

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Implant contamination as a cause of surgical site infection in spinal surgery: are single-use implants a reasonable solution? – a systematic review

A Combined Tie-Fastening Method for the Reusable Surgical Gown with Two Neck Tie Belts to Improve Wearing Comfort

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