Flash autoclave settings may influence eradication but not presence of well‐established biofilms on orthopaedic implant material

Abstract

Flash autoclaving is one of the most frequently utilized methods of sterilizing devices, implants or other materials. For a number of decades, it has been common practice for surgeons to remove implantable devices, flash autoclave and then reimplant them in a patient. Data have not yet indicated the potential for biofilms to survive or remain on the surface of orthopaedic-relevant materials following flash autoclave. In this study, monomicrobial and polymicrobial biofilms were grown on the surface of clinically relevant titanium materials and exposed to flash autoclave settings that included varying times and temperatures. Data indicated that when the sterilization and control temperatures of an autoclave were the same, biofilms were able to survive flash autoclaving that was performed for a short duration. Higher temperature and increased duration rendered biofilms non-viable, but none of the autoclave settings had the ability to remove or disperse the presence of biofilms from the titanium surfaces. These findings may be beneficial for facilities, clinics, or hospitals to consider if biofilms are suspected to be present on materials or devices, in particular implants that have had associated infection and are considered for re-implantation. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1543-1550, 2018.

Sterilization Protocol for Porous dental implants made by Selective Laser Melting

“…Implants with controlled porosity produced by Selective Laser Melting (SLM) are currently subject of research for better mechanical and biological properties. The difficulty to sterilize porous implantable devices is well known and finding an adequate sterilization protocol represents a challenge worldwide [25].…”

“…Considerable research was conducted on the issue of variation in sterilization capacity on the surface and the interior of implants [22,24,25,28].…”

Improve Integration of In Vitro Biofilm Body of Knowledge to Support Clinical Breakthroughs in Surgical Site Infection

“… 89 Decontamination of implants by autoclave is used midsurgery with some success; however, even a sterile physical biofilm matrix supports reinfection, and persister cells resist heat inactivation surprisingly well. 90 – 92 Implant retention is preferred if feasible because of recovery time, morbidity, and overall cost. 93 …”

“… 94 , 95 With the passage of time and with each unsuccessful débridement, 96 , 97 hardware removal becomes more necessary. 88 , 90 , 98 This can be completed as a single procedure; however, a two-step procedure enables prosthesis-free antibiotic treatment and tissue regeneration for weeks or months before implant replacement. Failing these, the repercussions become increasingly dire, requiring months or years of antibiotic therapy and can lead to amputation and/or premature death.…”