Hamstring graft bacterial contamination during anterior cruciate ligament reconstruction: clinical and microbiological study

Abstract

A high rate of contamination can be expected during autograft preparation for ACL reconstruction. Soaking the hamstring autograft in either bacitracin or 4 % chlorhexidine solution is effective for decontamination, particulary if graft is dropped on the floor.

Clinical Issues—December 2019

“…It also is important to note that contamination does not always lead to infection . No patient infections or incidents of septic arthritis were reported in these studies despite the contamination rates of the tissue.…”

“… inspecting instruments with lumens used to harvest the hamstring for bioburden; covering the area of the sterile table where the graft will be prepared until use; changing gloves before handling the graft (eg, preparation, implantation); moving the sterile table with the graft preparation site within the unidirectional ultraclean air delivery system air curtain; considering using sponges soaked in antibiotic solutions or antiseptic solutions to keep the graft moist after preparation; covering the prepared and wrapped graft in a sealed container or with a drape until implantation; and covering the patient's skin in the area where the graft might make contact during implantation. …”

“…More research is needed to determine the sources of ACL graft contamination and effective interventions to prevent contamination. Currently, the research shows that the contamination levels of ACL grafts on the sterile field range from 12% to 22%, but researchers do not yet understand what causes the contamination (eg, skin flora, extensive preparation, airborne contaminates) . It also is important to note that contamination does not always lead to infection .…”

“… removing any sutures from the graft and disposing of them before decontamination; using a separate sterile field for decontamination of the tissue to prevent contamination of the main sterile field from splash or splatter during decontamination; immersing the graft in 500 mg of vancomycin powder mixed with 100 mL of sterile normal saline solution, then wrapping the graft in gauze saturated with the mixture until it is used; or soaking the graft in a solution of 50,000 units of bacitracin mixed with 1 L of normal saline solution for three minutes; changing gown and gloves after decontamination is complete; and conducting a debriefing session with the team members involved to determine the root cause of the event and interventions to prevent another occurrence …”

“…One study found that vancomycin solution eliminated bacteria from ACL grafts that had been contaminated by harvesting and manipulation . A different study found that ACL grafts that had been dropped on the OR floor and left there for 15 seconds had a 50% contamination rate, but that soaking the dropped grafts in bacitracin solution or CHG for three minutes decreased the likelihood of tissue contamination to 3.3% and 0%, respectively . Soaking the grafts in povidone‐iodine solution resulted in a 15% contamination rate …”