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

Abstract

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.

In Vitro Bactericidal Efficacy of Nanostructured Ti6Al4V Surfaces is Bacterial Load Dependent

“…Surface modifications at the nanoscale have shown potential in killing Gram-positive and Gram-negative bacteria, but concentration-dependent experiments have not yet been performed. The concentration of bacteria that may attach to a titanium implant in a clinical environment is both uncertain and multifactorial, and influenced by the implant type, the clinical setting, and patient factors. − Regardless, prior studies on the bactericidal efficacy of nanostructured surfaces have considered concentrations of bacteria that may be much greater than those that may occur clinically. We, therefore, evaluated the effect of the initial inoculum concentration of S.…”

Optimisation of perioperative procedural factors to reduce the risk of surgical site infection in patients undergoing surgery: a systematic review

“…A systematic review [ 7 ] analysed the problem of contamination of implantable instruments and devices in spinal surgery. Many studies have shown significant contamination rates.…”

Postoperative Spinal Implant Infections (PSII)—A Systematic Review: What Do We Know So Far and What is Critical About It?

“…However, the risk for development of resistant bacteria is a possible downside in the long run, and thus the indication for prophylactic local AB administration should be critically reviewed. 59 Further strategies reducing the rate of PSII include AB prophylaxis, 60 an anterior surgical approach, 61 regular glove changing, 62,63 minimal invasive surgery, 64 and AB-impregnated fibrin sealant. 65 Antibiotic prophylaxis is a critical factor when avoiding PSII in the first place and should be based on the patient's weight, liver and renal function, possible allergies, incision to closure time, blood loss, and previous surgeries.…”

“…However, the risk for development of resistant bacteria is a possible downside in the long run, and thus the indication for prophylactic local AB administration should be critically reviewed. 59 Further strategies reducing the rate of PSII include AB prophylaxis, 60 an anterior surgical approach, 61 regular glove changing, 62 , 63 minimal invasive surgery, 64 and AB-impregnated fibrin sealant. 65 …”