Evaluation of the Time-dependent Contamination of Spinal Implants

Menekşe, Güner; Kuşçu, Ferit; Suntur, Bedia Mutay; Gezercan, Yurdal; Ateş, Tuncay; Özsoy, Kerem Mazhar; Ökten, Ali İhsan

doi:10.1097/brs.0000000000000944

Cited by 14 publications

(21 citation statements)

References 16 publications

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“…After 30 minutes, the contamination rate for covered implants was 0% versus 20% for uncovered implants. After 120 minutes, the contamination rate for covered implants was 18.2% versus 55% for uncovered implants . This study shows that exposure to air may contribute to sterile field contamination over time.…”

Section: Covering Portions Of the Sterile Fieldmentioning

confidence: 78%

“…If a decision is made to cover a portion of a sterile field, it should be covered as soon as reasonably possible. A quasi‐experimental study by Menekse et al reviewed contamination of covered and uncovered spinal implant trays by measuring the difference in contamination levels among the two groups over time and found that when the trays were opened, both sets of spinal implants were sterile. However, after 30 to 120 minutes, the contamination rate among groups was significantly different.…”

Section: Covering Portions Of the Sterile Fieldmentioning

confidence: 99%

“…The AORN guideline update does not provide guidance on how to cover portions of an open sterile field because there is limited evidence on this topic. Two studies used sterile surgical towels to cover some spinal implant trays and then compared contamination rates among the covered and uncovered trays . However, surgical towels are not barrier devices, and therefore do not meet the same standards as surgical drapes .…”

Section: Covering Portions Of the Sterile Fieldmentioning

confidence: 99%

“…Surgical drapes must resist liquid strikethrough that may carry microorganisms . Both studies found some contamination of covered spinal implant trays even though sterile surgical towels were used . Additional research is needed to determine the most effective covering method.…”

Section: Covering Portions Of the Sterile Fieldmentioning

confidence: 99%

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Clinical Issues—March 2019

deKay¹,

Cahn²

2019

AORN Journal

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Section: Covering Portions Of the Sterile Fieldmentioning

confidence: 78%

Section: Covering Portions Of the Sterile Fieldmentioning

confidence: 99%

Section: Covering Portions Of the Sterile Fieldmentioning

confidence: 99%

Section: Covering Portions Of the Sterile Fieldmentioning

confidence: 99%

See 2 more Smart Citations

Clinical Issues—March 2019

deKay¹,

Cahn²

2019

AORN Journal

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“…2,3 Surgical implants and instruments have also been demonstrated to become contaminated in a progressive, time-dependent manner in spine surgery. 4,5 The posterior elements themselves (spinous processes, lamina, facets) have even been demonstrated to become contaminated in a time-dependent manner. [6][7][8] Contamination can occur after both simple and complex spinal surgery, 9 and has been demonstrated to occur more frequently at the surgical field than at a control location in the operating room, such as at an air conditioner vent or near the doorway.…”

Section: Discussionmentioning

confidence: 99%

Operative Field Debris Often Rises to the Level of the Surgeon's Face Shield During Spine Surgery: Are Orthopedic Space Suits a Reasonable Solution?

et al. 2019

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Background: The present study intended to identify debris in the spine surgical field that frequently rises to the level of the surgeon's face during several different elective spine procedures. Unlike other areas of orthopedic surgery where infection risk is of high concern, in spine surgery the surgical team usually uses a nonsterile face mask instead of a protective space suit with a sterile face shield. It is possible that blood or bone burr particles striking the surgeon's face mask represent a potential source of infection if they ricochet back into the operative field. Methods: We reviewed 46 consecutive, elective spine surgeries between May 2015 and August 2015 from a singlesurgeon practice. For each surgery, every member of the surgical team wore sterile (space suit) personal protective equipment. After each procedure, the face shield was carefully inspected by 2 members of the surgical team to identify patient blood, tissue, or bone burr dust present on the face shield. Results: The rate of surgeon face shield debris inspected for each case overall was 38/46 (83%). The rate of first assistant face shield debris inspected per case was 16/46 (35%). The scrub technician had a 0% rate of face mask debris on inspection. The highest debris exposure rates occurred with transforaminal lumbar interbody fusions (100%), open laminectomy and fusions (100%), and anterior cervical discectomy and fusions 43/46 (93%). Conclusions: There is a high rate of blood and tissue debris contact that occurs during spine surgery, and it is procedure dependent. Spine surgeons may consider using sterile shields particularly in high-risk cases to protect themselves and their patients. Level of Evidence: 4.

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Time-dependent surgical instrument contamination begins earlier in the uncovered table than in the covered table

Uzun

Mısır

Özçamdallı

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Time‐dependent surgical instrument contamination and the effect of covering during arthroplasty have not been investigated. This study aimed to evaluate time‐dependent contamination of surgical instruments and the effect of covering on contamination as well as to perform bacterial typing of contaminated samples. The hypothesis was that covering the surgical instruments would decrease contamination rates. Methods Sixty patients who underwent total knee arthroplasty were randomized and divided into two groups: surgical instruments covered with a sterile towel or surgical instruments left uncovered. K‐wires were used to extract microbiological samples. The K‐wires were placed in a liquid culture medium at 0, 15, 30, 60, 90, and 120 min. After 24‐h incubation period, samples from liquid cultures were cultured on blood agar using swabs. Samples with growth after 48 h were considered contaminated. Microscopic, staining, and biochemical properties were used for bacterial typing. Results Bacterial growth started after 30 and 60 min in the uncovered and covered groups, respectively. An increase in the number of K‐wires contaminated with time was detected. At least 10,000 CFU/mL bacterial load was observed in the culture samples. Contamination was more significant in the uncovered group. A statistically significant difference in contamination was found between the uncovered and covered groups at 30‐, 60‐, 90‐, and 120 min (p = 0.035, p = 0.012, p = 0.024, and p = 0.037, respectively). The most common bacteria on the contaminated instruments were coagulase‐negative Staphylococci (60.4%), Staphylococcus aureus (22.9%), and Streptococcus agalactia (16.7%), respectively. Conclusion The risk of contamination increases with time. However, it may decrease if surgical instruments are covered. In the clinical practice, empiric antibiotic regimens based on the type of identified microorganisms in this study may be developed for postoperative periprosthetic joint infection prophylaxis. Level of evidence Prognostic, Level II.

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Evaluation of the Time-dependent Contamination of Spinal Implants

Abstract: 2.

Cited by 14 publications

References 16 publications

Clinical Issues—March 2019

Clinical Issues—March 2019

Operative Field Debris Often Rises to the Level of the Surgeon's Face Shield During Spine Surgery: Are Orthopedic Space Suits a Reasonable Solution?

Time-dependent surgical instrument contamination begins earlier in the uncovered table than in the covered table

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