The Far Side Opposite the Surgeon is Most Prone to Contamination From the C-Arm

Abstract

Objective: Fluoroscopy is used in many orthopaedic procedures. The C-Arm drape is known to be easily contaminated during orthogonal imaging. However, it is unknown if one area of the operative field is more prone to contamination than another. The purpose of this study was to determine if secondary transfer of contaminate from the undraped portion of the C-Arm occurs. Methods: A C-Arm was utilized with standardized draping in a simulated operating room. We used a simulated contaminant: a fluorescent powder that phosphoresces under ultraviolet light. The powder was placed over nonsterile portions. A darkened room with a black light, and a camera was used. C-Arm movements were simulated by cycling through lateral to Anteroposterior imaging. Images were taken before (control) and after cycles of orthogonal imaging. The change in light intensity was quantified at each time point over each area as a percentage of change. Results: Contamination of the surgical field was observed in all areas after 15 cycles, with the area adjacent to the C-Arm being most pronounced. A linear increase in intensity with increased cycles was observed (R 2 = 0.297; P = 0.036), with the mean increase in intensity of 5% after 15 cycles (95% confidence interval, 1.97–7.86). The remaining areas (closest to surgeon and middle) showed an increase as well but were not significant (P > 0.05). Conclusions: Secondary contamination of the surgical field from the C-Arm occurs. The area most prone to contamination is the area immediately adjacent to the fluoroscopy unit, usually opposite the surgeon.

Time to entry point and distal locking of intramedullary nails: a methodological phantom study comparing biplanar and uniplanar surgical imaging

“…The inevitable swinging of the uniplanar C-arm confers an increased risk of surgical field contamination [ 4 , 11 ]. Contamination of the surgical field was linearly increased with increased cycles/swings of the C-arm with all areas contaminated after 15 cycles in a methodological study using fluorescent powder contaminant [ 13 ]. The area closest to the C-arm had the most pronounced contamination.…”

Evaluation of a novel C‐Arm draping technique to minimize surgical field contamination and surgery time

“…Sterile drapes are at risk of becoming contaminated by floor particles when transitioning the C‐Arm between the AP and lateral positions, leading to secondary contamination of the surgical field 11,16 . If the surgeon's gloves contact the contaminated drape, tertiary transfer of contaminates may further compromise sterility 16 . For these reasons, limiting contaminates from reaching higher areas of the sterile drape is believed to limit the risk of surgical site infection rates 11 .…”

“…Two ounces of melamine resin powder, also known as Glo Germ, was spread onto the area underneath the operative table and C‐Arm. This melamine resin powder has been previously used in various infectious disease studies to simulate the spread of contamination 12–16 . Its ability to illuminate under ultraviolet (UV) light is used to identify areas of contamination that would have otherwise been undetected.…”

Examination of fluoroscopy monitor as a source of indirect bacterial contamination in orthopaedic surgery

“…The location of the monitor unit is positioned to the specific surgery for ergonomic purposes. Prior studies have shown the C-arm component of the system as a potential source of bacterial contamination, especially as the mobile unit traverses in and out of the sterile field (Biswas et al, 2008;Gershkovich et al, 2016;Peters et al, 2012;Zuelzer et al, 2019). No study to our knowledge has looked at the potential of the monitor to serve as a source of contamination.…”