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

Abstract

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.

The safety of a novel single-drape cover for sterile back tables in the operating room compared to the standard two-drape method: an experimental study

“…While, in real surgery conditions, Uzun et al [ 25 ] showed bacterial growth on PSBTs started after 30 and 60 min in the uncovered sets (6 of 30 [20%]) and covered groups (2 of 30 [6.7%]), respectively ( P = 0.024). Dalstrom et al [ 16 ] found that no contamination has occur in the covered group while, rate of 30% contamination appeared in group without cover after 4 hours.…”

“…Uzun et al [ 25 ] demonstrated the contamination of uncovered and covered PSBTs increases with over time (uncovered group; contamination rate instrument trays with increasing time was 20% at 30 min vs. 43.4% at 120 min). Hence, covering may serves as a barrier to ABCPs and several research support the covering sterile areas to diminish the potential for contamination in the OR [ 12 , 15 , 16 ].…”

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

“…As shown by multiple studies, an important factor of implant and instrument contamination is their exposure to air, which is why the duration of this exposure needs to be as short as possible and laminar airflow ventilation systems should be installed [24][25][26][27]. Additionally, surgical equipment including gloves and gowns play an important role in bacterial contamination.…”

“…Here, they were able to show that culture positivity directly correlated with the time the trays were openly exposed. Covering the surgical trays led to a significant reduction in contamination rates [25][26][27]. Using a guard in order to shield screws and other implants intraoperatively led to a reduction in bioburden compared to unguarded screws as shown by Agarwal et al in 10 sterile packaged pedicle screws in 2019 [28].…”

Instrument tables equipped with local unidirectional airflow units reduce bacterial contamination during orthopedic implant surgery in an operating room with a displacement ventilation system

“…Surgical site infection (SSI) is a dreaded complication after implant surgery [ [1] , [2] , [3] ] often leading to resource demanding treatment and implant replacement [ [4] , [5] , [6] ]. Airborne contamination of the wound, either directly, or indirectly through air-contaminated instruments or implants, has been described as an important risk factor for SSI in orthopedic implant surgery [ [7] , [8] , [9] , [10] ]. Factors such as ventilation system, number of door openings, persons present, size of the operating room (OR) and type of clothing affect airborne microbial contaminants during surgery [ 11 , 12 ].…”