Is Repetitive Intraoperative Splash Basin Use a Source of Bacterial Contamination in Total Joint Replacement?

Abstract

Splash basins are used in arthroplasty cases to wash instruments. Several studies in the literature have shown these basins being a potential source of bacterial infection. This study assesses the risk of contamination of intraoperative splash basins used to wash and store instruments. A total of 46 random clean primary arthroplasty cases (32 hips, 13 knees, and 1 unicondylar knee) were studied by taking cultures of sterile splash basins as soon as they are opened (controls) and again at wound closure after instruments and debris have come into contact with the sterile water. All cultures were taken with sterile culture swabs and sent to the laboratory for aerobic, anaerobic, and fungal culture. Outcome measured was any positive culture. A total of 92 cultures from 46 cases were tested. Only 1 (2.17%) control culture, which grew Streptococcus viridans, was positive for bacterial growth. One of 46 samples (2.17%) taken at wound closure was positive for coagulase-negative Staphylococcus. Mean time between basin opening and wound closure was 180±45 minutes. For the 1 infected sample taken at the conclusion of the case, it was 240 minutes. Previous studies show contamination rates as high as 74% for splash basins used intraoperatively. Our study contradicts the belief that splash basins are a high source of infection, with only 2.17% of basins showing contamination. Splash basins can be a potential source of contamination, but the risk is not as high as previously cited in the orthopedic literature.

Bacterial contamination of the wound during primary total hip and knee replacement

“…2 previous studies, where water taken from the splash basin was passed through a grid membrane and the membrane filter was then cultured, gave contamination rates of 74% (Baird et al 1984) and 24% (Anto et al 2006). A recent study in which swabs were used to take cultures from the splash basin found a contamination rate of only 2% (Glait et al 2011), and the authors speculated that the discrepancy might be partly due to differences in sampling methods—but our findings do not support this. To our knowledge, there have been no studies that have clearly linked the splash basin to infection.…”

Surgical Attire and the Operating Room: Role in Infection Prevention

“…Splash basin contamination has been reported in the literature to range from 2% to 74% [58][59][60] . Irrigation fluid on the back table may also become contaminated over time.…”

Surgical Wound Irrigation: Strategy for Prevention of Surgical Site Infection

“…9 Regarding the containers for the irrigation solution at the procedure field, one study showed that in 13 of 21 irrigating solutions in containers were contaminated at the end of the surgical procedures. [10][11][12] Our experience recommends the use of sterile devices and adapters to avoid contamination of the solution and hence reduce SSI incidence.…”

“…9 Regarding the containers for the irrigation solution at the procedure field, one study showed that in 13 of 21 irrigating solutions in containers were contaminated at the end of the surgical procedures. [10][11][12] Our experience recommends the use of sterile devices and adapters to avoid contamination of the solution and hence reduce SSI incidence.The Food and Drugs Administration (FDA) has warned the inappropriate use of antibiotics in surgical wound irrigation as it increases antimicrobial resistance and reduces the effectiveness of established antibiotic treatments and increased health costs and mortality. 13,14 The antiseptics are also commonly used (the most common one is the iodopovidone) in the surgical wound irrigation to exert a bactericidal effect, but it also lacks FDA's authorization.…”