Single-use instrumentation in posterior lumbar fusion could decrease incidence of surgical site infection: a prospective bi-centric study

Litrico, S.; Recanati, Geoffrey; Gennari, Antoine; Maillot, Cédric; Saffarini, Mo; Huec, Jean-Charles Le

doi:10.1007/s00590-015-1692-4

Cited by 19 publications

(19 citation statements)

References 42 publications

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“…Whereas intraoperative preventative measure focuses on avoiding contamination of the clean and sterile implant, provided to the OR, during the surgery. An example of preoperative preventative measure is the study done by Litrico et al, 8 where they highlighted evidences of reduced SSI by avoiding repeated reprocessing in the hospital. An example of intraoperative preventative measures is the study done by Rehman et al, 12 where they highlighted evidence of reducing SSI by using a fresh pair of gloves, every time before touching the implant during the procedure.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Intraoperative Implant Prophylaxis in Reducing Intraoperative Microbial Contamination

Agarwal

Lin

Wang

et al. 2018

Global Spine Journal

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Study Design:A prospective single-center study.Objectives:Assess to what degree contamination of pedicle screws occur in standard intraoperative practice and if use of an impermeable guard could mitigate or reduce such an occurrence.Methods:Two groups of sterile prepackaged pedicle screws, one with an intraoperative guard (group 1) and the other without such a guard (group 2), each consisting of 5 samples distributed over 3 time points, were loaded onto the insertion device by the scrub tech and left on the sterile table. Approximately 20 minutes later, the lead surgeon who had just finished preparing the surgical site touches the pedicle screw. Then instead of implantation it was transferred to a sterile container using fresh clean gloves for bacterial and gene analysis. Guarded screw implies that even after unwrapping from the package, the screw carries an impermeable barrier along its entire length, which is only removed seconds prior to implantation.Results:The standard unguarded pedicle screws presented bioburden in the range of 105 to 107 (colony forming units/implant) with bacterial genus mostly consisting of Staphylococcus and Micrococcus, the 2 most common genera found in surgical site infection reports. The common species among them were Staphylococcus epidermis, Staphylococcus aureus, Micrococcus luteus, and Staphylococcus pettenkoferi, whereas the guarded pedicle screws showed no bioburden.Conclusions:Shielding the pedicle screws intraoperatively using a guard provides a superior level of asepsis than currently practiced. All unshielded pedicles screws were carrying bioburden of virulent bacterial species, which provides an opportunity for the development of postoperative infections.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Intraoperative Implant Prophylaxis in Reducing Intraoperative Microbial Contamination

Agarwal

Lin

Wang

et al. 2018

Global Spine Journal

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“…4 Beldame et al reported results on 26 contaminated gloves, which came from all gloved surgical team members (operator, scrub nurse, and assistant) of cutaneous origin. 7 The contamination was equally divided between dominant and nondominant (13) hands. They also showed that a regular change of gloves resulted in a sterile state in 80% of cases.…”

Section: Surgical Gloves As a Vehicle For Contamination (5 Articles)mentioning

confidence: 99%

Implant Prophylaxis: The Next Best Practice Toward Asepsis in Spine Surgery

Agarwal

Schultz²,

Goel

et al. 2018

Global Spine Journal

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Study Design:A literature review.Objectives:An evaluation of the contaminants prevalent on implants used for surgery and the aseptic methods being employed against them.Methods:PubMed was searched for articles published between 2000 and 2017 for studies evaluating the contaminants present on spine implants, and associated pre- and intraoperative implant processing and handling methodology suggested to avoid them. Systematic reviews, observational studies, bench-top studies, and expert opinions were included.Results:Eleven studies were identified whose major focus was the asepsis of implants to reduce the incidence of surgical site infection incidences during surgery. These studies measured the colony forming units of bacteria on sterilized implants and/or gloves from the surgeon, scrub nurse, and assistants, as well as reductions of surgical site infection rates in spine surgery due to changes in implant handling techniques. Additionally, the search included assessments of endotoxins and carbohydrates present on reprocessed implants. The suggested changes to surgical practice based on these studies included handling implants with only fresh gloves, keeping implants covered until the immediate time of use, reducing operating room traffic, avoiding reprocessing of implants (ie, providing terminally sterilized implants), and avoiding touching the implants altogether.Conclusions:Both reprocessing (preoperative) and handling (intraoperative) of implants seem to lead to contamination of sterilized implants. Using a terminally sterilized device may mitigate reprocessing (preoperative implant prophylaxis), whereas the use of fresh gloves for handling each implant and/or a permanent shielding technique (intraoperative implant prophylaxis) could potentially avoid recontamination at the theatre.

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“…At the same time, clinical outcomes were similar. The authors therefore concluded that wrapping screws and rods in sterile packs until insertion into the patient reduces infection rates by a reduction of exposure and of repetitive hospital sterilization [44].…”

Section: Discussionmentioning

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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Single-use instrumentation in posterior lumbar fusion could decrease incidence of surgical site infection: a prospective bi-centric study

Abstract: Level II, prospective randomized bi-centric study.

Cited by 19 publications

References 42 publications

Efficacy of Intraoperative Implant Prophylaxis in Reducing Intraoperative Microbial Contamination

Efficacy of Intraoperative Implant Prophylaxis in Reducing Intraoperative Microbial Contamination

Implant Prophylaxis: The Next Best Practice Toward Asepsis in Spine Surgery

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

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