Intraoperative bacterial contamination in operations for joint replacement

Abstract

A ll surgical operations have the potential for contamination, and the equipment used can harbour bacteria. We collected samples from 100 elective primary hip and knee arthroplasties. These showed rates of contamination of 11.4% for the sucker tips, 14.5% for light handles, 9.4% for skin blades and 3.2% for the inside blades used during surgery; 28.7% of gloves used for preparation were also contaminated. Of the samples taken from the collection bags used during hip arthroplasty, 20% grew bacteria, which represents a significant microbial reservoir. Also, 17% of theatre gowns were contaminated at the end of the operation. Contamination was found in 10% of the needles used during closure of the fascia. Overall, 76% of the organisms grown were coagulase-negative staphylococcus. A total of 63% of operations showed contamination in the field of operation. Some changes in practice are suggested. Follow-up for a minimum of two years revealed one deep infection but the organism was not identified as a contaminant. These data provide a baseline for studying the bacteriology of the surgery of revision arthroplasty. [Br] 1999;81-B:886-9. J Bone Joint Surg

Postoperative Deep Infection After Cemented Versus Cementless Total Hip Arthroplasty: A Meta-Analysis

“…First, the longer operation time for cementing procedure might be one reason. Long operating time is the most important risk factor of surgical site infection in all kinds of operation [36][37][38][39]. Among analyzed 8 studies, only 2 studies described operation time and operation time was longer in cemented group than cementless group ( 130 vs 112 min) [36,46].…”

“…Long operating time is the most important risk factor of surgical site infection in all kinds of operation [36][37][38][39]. Among analyzed 8 studies, only 2 studies described operation time and operation time was longer in cemented group than cementless group ( 130 vs 112 min) [36,46]. Second, the bone cement itself may create vulnerable conditions to infection [36,40,41].…”

“…Among analyzed 8 studies, only 2 studies described operation time and operation time was longer in cemented group than cementless group ( 130 vs 112 min) [36,46]. Second, the bone cement itself may create vulnerable conditions to infection [36,40,41]. These conditions include chemical toxicity of unreacted monomer liquid [42], membrane formation at the cement-bone interface, and bone necrosis due to heat during the polymerization of cement [43,44].…”

Which Regions of the Operating Gown Should be Considered Most Sterile?

“…Similar studies assessing the sterility of operating room staff have been performed: glove contamination has been documented in 14% to 57% of orthopaedic cases depending on the subspeciality [2,5,6,15], and in previous reviews, the overall incidence of glove perforation ranged between 9% and 37% [6,26,30].…”

“…Surgical instruments and other equipment used in the operative field with reported contamination rates are light handles (0% to 14%) [5,12], sucker tips (11% to 41%) [5,10,22,23], scalpel blades (9%) [5], and fascial needles Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research.…”