The effect of the surgical helmet system on intraoperative contamination in arthroplasty surgery

Abstract

AimsThe surgical helmet system (SHS) was developed to reduce the risk of periprosthetic joint infection (PJI), but the evidence is contradictory, with some studies suggesting an increased risk of PJI due to potential leakage through the glove-gown interface (GGI) caused by its positive pressure. We assumed that SHS and glove exchange had an impact on the leakage via GGI.MethodsThere were 404 arthroplasty simulations with fluorescent gel, in which SHS was used (H+) or not (H-), and GGI was sealed (S+) or not (S-), divided into four groups: H+S+, H+S-, H-S+, and H-S-, varying by exposure duration (15 to 60 minutes) and frequency of glove exchanges (0 to 6 times). The intensity of fluorescent leakage through GGI was quantified automatically with an image analysis software. The effect of the above factors on fluorescent leakage via GGI were compared and analyzed.ResultsThe leakage intensity increased with exposure duration and frequency of glove exchanges in all groups. When SHS was used and GGI was not sealed (H+S-), the leakage intensity via GGI had the fastest increase, consistently higher than other groups (H+S+, H-S+ and H-S-) after 30 minutes (p < 0.05) and when there were more than four instances of glove exchange (p < 0.05). Additionally, the leakage was strongly correlated with the duration of exposure (rs = 0.8379; p < 0.050) and the frequency of glove exchange (rs = 0.8198; p < 0.050) in H+S-. The correlations with duration and frequency turned weak when SHS was not used (H-) or GGI was sealed off (S+).ConclusionDue to personal protection, SHS is recommended in arthroplasties. Meanwhile, it is strongly recommended to seal the GGI of the inner gloves and exchange the outer gloves hourly to reduce the risk of contamination from SHS.Cite this article: Bone Jt Open 2023;4(11):859–864.

Antibiotic calcium sulphate beads lower the bacterial burden and prevent infection in a mouse model of periprosthetic joint infection

“…Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA) and is the most common indication for revision. [1][2][3][4][5] It is associated with considerable morbidity and cost as treatment may include several operations with prolonged antibiotic treatment, and the rates of failure remain high. [6][7][8][9] The establishment of a bacterial biofilm on the prosthesis is the final common pathway in the pathogenesis of PJI.…”

“…Organisms may contaminate it or the periprosthetic tissue at the time of surgery, by the spread of infection from the wound, or by haematogenous seeding. 3,8 The use of local prophylactic antibiotics has been widely reported. 10,11 Both pre-clinical and retrospective data have supported the local use of vancomycin in spinal surgery.…”

“…Organisms may contaminate it or the periprosthetic tissue at the time of surgery, by the spread of infection from the wound, or by haematogenous seeding. 3,8…”