Reprocessing safety issues associated with complex-design orthopaedic loaned surgical instruments and implants

Costa, Dayane de Melo; Lopes, Lillian Kelly de Oliveira; Vickery, Karen; Watanabe, Evandro; Vasconcelos, Lara Stefânia Netto de Oliveira Leão; Paula, Milena Cristina de; Melo, Dulcelene Sousa; Hu, Honghua; Deva, Anand K.; Tipple, Anaclara Ferreira Veiga

doi:10.1016/j.injury.2018.09.006

Cited by 26 publications

(25 citation statements)

References 14 publications

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“…1 implant tray with 164 pedicel screws 1. 3 types of contaminants: corrosion, saccharide of unknown origin, soap residue 2. observed reprocessing time was < 2 h Repeatedly reprocessed pedicle screws may be source of SSI Pinto et al (2010) [ 8 ] Surgical implants 227 samples (76 from clean surgeries, 76 from contaminated surgeries, 75 from infected surgeries) 47% microbial contamination of implants in clean surgeries, 70% in contaminated, and 80% in infected surgeries Most of the microorganisms recovered are covered by the cleaning and sterilization process; antibiotic prophylaxis is important in clean surgeries Lopes et al (2019) [ 9 ] FMRs and DGs 9 FMRs and 9 DGs (3 rinsing, 3 manual cleaning, 3 manual plus automated cleaning) 100% ATP contamination in rinsed only with 2–2.5 log 10 fold reduction after manual or manual plus automated cleaning; soil present in all groups Reusable surgical instruments show residual biological soil after reprocessing, which may have an adverse effect on patient outcome Costa et al (2018) [ 10 ] FMRs, DGs, and single-use screws in clinical use for > 1 year 73 FMRs (16 ATP, 8 CFU, 40 visual, 9 SEM), 19 DGs (8 ATP, 8 visual, 3 SEM), 123 screws (24 CFU, 90 visual, 9 SEM) 1. FMRs: 75% showed ATP, 85% visible soil, 63% protein after cleaning 2.…”

Section: Resultsmentioning

confidence: 99%

“…Similar results were shown by Costa et al who assessed 215 surgical instruments, which had been in clinical use for over a year, for residual ATP, protein, bacterial contamination, endotoxin and biofilm. After sterilization, biofilm and soil were still detectable by electron microscopy [10]. A study by Smith et al implicated that standard sterilization of cannulated drills may ineffectively sterilize cannulated drills and thus lead to bacterial contamination of these instruments [11].…”

Section: Preoperative Sources Of Implant Contaminationmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Preoperative Sources Of Implant Contaminationmentioning

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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“…These researchers frequently observed inaccessible, dysfunctional and unmaintained autoclaves in LMIC healthcare facilities. As such, manual instrument cleaning is common in LMICs amid resource constraints but remains much less effective than automated cleaning (Costa et al, 2018; Oosthuysen et al, 2014). Inadequate cleaning has been associated with bioburden and debris retention (Fast et al, 2017) as well as biofilm formation, particularly in complex-design instruments that are impractical to clean manually (Costa et al, 2018).…”

Section: Resultsmentioning

confidence: 99%

“…Several authors highlighted consequential policy-practice gaps. Costa et al (2018) noted that policy standards in Brazil required only cleaning, and not necessarily disinfection and sterilisation, before returning loaned instrument sets. During SP training and mentoring programmes in Ethiopian and Tanzanian hospitals, Fast et al (2019aFast et al ( , 2019b found that workers were apprehensive about using enzymatic detergents or soapy water in place of corrosive 0.5% chlorine solutions, a recommendation in alignment with recent changes to WHO (WHO and PAHO, 2016) evidence-based guidelines.…”

Section: Challenges To Sterile Processing Practicementioning

confidence: 99%

Sterile processing in low- and middle-income countries: an integrative review

Cuncannon

Dosani

Fast

2020

Journal of Infection Prevention

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Background: Worldwide disparities in surgical capacity are a significant contributor to health inequalities. Safe surgery and infection prevention and control depend on effective sterile processing (SP) of surgical instruments; however, little is known about SP in low- and middle-income countries (LMICs), where surgical site infection is a major cause of postoperative morbidity and mortality. Aim: To appraise and synthesise available evidence on SP in LMICs. Methods: An integrative review of research literature was conducted on SP in LMICs published between 2010 and 2020. Studies were appraised and synthesised to identify challenges and opportunities in practice and research. Results: Eighteen papers met the inclusion criteria for qualitative analysis. Challenges to advancing SP include limited available evidence, resource constraints and policy-practice gaps. Opportunities for advancing SP include tailored education and mentoring initiatives, emerging partnerships and networks that advance implementation guidelines and promote best practices, identifying innovative approaches to resource constraints, and designing and executing quality assurance and surveillance programmes. Discussion: Research investigating safe surgery, including SP, in LMICs is increasing. Further research and evidence are needed to confirm the generalisability of study findings and effectiveness of strategies to improve SP practice in LMICs. This review will help researchers and stakeholders identify opportunities to contribute. The burdens of unsafe surgery transcend geopolitical borders, and the global surgery and research communities are called upon to negotiate historical and present-day inequities to achieve safe surgery for all.

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“…El ciclo de vida de la descontaminación muestra las características más destacadas de ésta, en la que cada paso es tan importante como el siguiente. El ciclo de descontaminación del instrumental quirúrgico reusable es el siguiente: 8 1. Limpieza, 2.…”

Section: Descontaminación De Dispositivos Médicos E Instrumentos Quirúrgicosunclassified

Ambiente limpio en el quirófano y descontaminación de instrumentos quirúrgicos en ortopedia

Reyes¹,

Lara²,

Morado³

2020

Ortho-Tips

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La contaminación del ambiente de quirófano juega un papel preponderante en la transmisión de microorganismos. Es necesario que se realice una limpieza exhaustiva diaria del quirófano al terminar cada cirugía, y que exista una buena ventilación en el quirófano para prevenir la contaminación de heridas quirúrgicas por aire contaminado y por los microorganismos que se desprenden de la piel. Además, el tratamiento apropiado de los dispositivos médicos y quirúrgicos especializados para Ortopedia y Traumatología requiere atención especial para disminuir la carga bacteriana de cepas resistentes. En este artículo revisaremos las medidas estandarizadas que disminuyen la probabilidad de infección del sitio quirúrgico en cirugía ortopédica y que requieren colaboración con el equipo de enfermería en procesos de limpieza, desinfección, esterilización y almacenaje ordenado.

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Reprocessing safety issues associated with complex-design orthopaedic loaned surgical instruments and implants

Cited by 26 publications

References 14 publications

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

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

Sterile processing in low- and middle-income countries: an integrative review

Ambiente limpio en el quirófano y descontaminación de instrumentos quirúrgicos en ortopedia

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