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Time-dependent surgical instrument contamination begins earlier in the uncovered table than in the covered table

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Time-dependent surgical instrument contamination and the effect of covering during arthroplasty have not been investigated. This study aimed to evaluate time-dependent contamination of surgical instruments and the effect of covering on contamination as well as to perform bacterial typing of contaminated samples. The hypothesis was that covering the surgical instruments would decrease contamination rates.

Methods

Sixty patients who underwent total knee arthroplasty were randomized and divided into two groups: surgical instruments covered with a sterile towel or surgical instruments left uncovered. K-wires were used to extract microbiological samples. The K-wires were placed in a liquid culture medium at 0, 15, 30, 60, 90, and 120 min. After 24-h incubation period, samples from liquid cultures were cultured on blood agar using swabs. Samples with growth after 48 h were considered contaminated. Microscopic, staining, and biochemical properties were used for bacterial typing.

Results

Bacterial growth started after 30 and 60 min in the uncovered and covered groups, respectively. An increase in the number of K-wires contaminated with time was detected. At least 10,000 CFU/mL bacterial load was observed in the culture samples. Contamination was more significant in the uncovered group. A statistically significant difference in contamination was found between the uncovered and covered groups at 30-, 60-, 90-, and 120 min (p = 0.035, p = 0.012, p = 0.024, and p = 0.037, respectively). The most common bacteria on the contaminated instruments were coagulase-negative Staphylococci (60.4%), Staphylococcus aureus (22.9%), and Streptococcus agalactia (16.7%), respectively.

Conclusion

The risk of contamination increases with time. However, it may decrease if surgical instruments are covered. In the clinical practice, empiric antibiotic regimens based on the type of identified microorganisms in this study may be developed for postoperative periprosthetic joint infection prophylaxis.

Level of evidence

Prognostic, Level II.

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References

  1. Alamanda VK, Springer BD (2018) Perioperative and modifiable risk factors for periprosthetic joint infections (PJI) and recommended guidelines. Curr Rev Musculoskelet Med 11(3):325–331

    Article  Google Scholar 

  2. Alamanda VK, Springer BD (2019) The prevention of infection 12: modifiable risk factors. Bone Joint J 101-B(1 Suppl A):3–9

    Article  CAS  Google Scholar 

  3. Badawy M, Espehaug B, Fenstad AM, Indrekvam K, Dale H, Havelin LI, Furnes O (2017) Patient and surgical factors affecting procedure duration and revision risk due to deep infection in primary total knee arthroplasty. BMC Musculoskelet Disord 18(1):544

    Article  Google Scholar 

  4. Bible JE, O’Neill KR, Crosby CG, Schoenecker JG, McGirt MJ, Devin DJ (2013) Implant contamination during spine surgery. Spine J 13(6):637–640

    Article  Google Scholar 

  5. Campbell DA Jr, Henderson WG, Englesbe MJ, Hall BL, O’Reilly M, Bratzler D, Dellinger EP, Neumayer L, Bass BL, Hutter MM, Schwartz J, Ko C, Itani K, Steinberg SM, Siperstein A, Sawyer RG, Turner DJ, Khuri SF (2008) Surgical site infection prevention: the importance of operative duration and blood transfusion—results of the first American College of Surgeons–National Surgical Quality Improvement Program Best Practices Initiative. J Am Coll Surg 207:810–820

    Article  Google Scholar 

  6. Dalstrom DJ, Venkatarayappa I, Manternach AL, Palcic MS, Heyse BA, Prayson MJ (2008) Time-dependent contamination of opened sterile operating-room trays. J Bone Joint Surg Am 90(5):1022–1025

    Article  Google Scholar 

  7. George DA, Drago L, Scarponi S, Gallazzi E, Haddad FS, Romano CL (2017) Predicting lower limb periprosthetic joint infections: a review of risk factors and their classification. World J Orthop 8(5):400–411

    Article  Google Scholar 

  8. Gristina AG, Costerton JW (1984) Bacterial adherence and the glycocalyx and their role in musculoskeletal infection. Orthop Clin N Am 15:517–535

    CAS  Google Scholar 

  9. Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA (2016) Periprosthetic joint infection. Lancet 387(10016):386–394

    Article  Google Scholar 

  10. Kong L, Cao J, Zhang Y, Ding W, Shen Y (2017) Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J 14(3):529–536

    Article  Google Scholar 

  11. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J (2012) Economic burden of periprosthetic joint infection in the United States. J Arthroplast 27(8 Suppl):61–65.e1

    Article  Google Scholar 

  12. Menekse G, Kuscu F, Suntur BM, Gezercan Y, Ates T, Ozsoy KM, Okten AI (2015) Evaluation of the time-dependent contamination of spinal implants: prospective randomized trial. Spine (Phila Pa 1976) 40(16):1247–1251

    Article  Google Scholar 

  13. Namba RS, Inacio MC, Paxton EW (2013) Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am 95:775–782

    Article  Google Scholar 

  14. Peersman G, Laskin R, Davis J, Peterson MG, Richart T (2006) Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J 2:70–72

    Article  CAS  Google Scholar 

  15. Tsai DM, Caterson EJ (2014) Current preventive measures for health-care associated surgical site infections: a review. Patient Saf Surg 8(1):42

    Article  Google Scholar 

  16. Wang Q, Goswami K, Shohat N, Aelirezaie A, Manrique J, Parvizi J (2019) Longer operative time results in a higher rate of subsequent periprosthetic joint infection in patients undergoing primary joint arthroplasty. J Arthroplast 34(5):947–953

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Training and Research Hospital, Ordu University, Ordu, Turkey

    Erdal Uzun & Alper Cirakli

  2. Department of Orthopedics and Traumatology, Gaziosmanpasa Taksim Training and Research Hospital, Karayollari Mah. Osmanbey Cad. 621. Sk, Gaziosmanpasa, Istanbul, Turkey

    Abdulhamit Misir

  3. Department of Orthopedics and Traumatology, Training and Research Hospital, Ahi Evran University, Bursa, Turkey

    Mustafa Ozcamdalli

  4. Department of Internal Medicine, Ilker Celikcan Physical Therapy and Rehabilitation Hospital, Bursa, Turkey

    Emine Eylul Kizkapan

  5. Department of Microbiology, Training and Research Hospital, Ordu University, Ordu, Turkey

    Mustafa Kerem Calgin

Authors
  1. Erdal Uzun
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  2. Abdulhamit Misir
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  3. Mustafa Ozcamdalli
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  4. Emine Eylul Kizkapan
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  5. Alper Cirakli
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  6. Mustafa Kerem Calgin
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Corresponding author

Correspondence to Abdulhamit Misir.

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Conflict of interest

Erdal Uzun, Abdulhamit Misir, Mustafa Ozcamdalli, Emine Eylul Kizkapan, Alper Cirakli, and Mustafa Kerem Calgin declare that they have no actual or potential conflict of interest including any financial, personal, or other relationships with other people or organizations within 3 years of beginning the submitted work that could inappropriately influence, or be perceived to influence, their work.

Ethical approval

Ordu University, Faculty of Medicine clinical investigations ethics committee approved the study protocol (Approval date/number:18.10.2018/2018-215).

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Uzun, E., Misir, A., Ozcamdalli, M. et al. Time-dependent surgical instrument contamination begins earlier in the uncovered table than in the covered table. Knee Surg Sports Traumatol Arthrosc 28, 1774–1779 (2020). https://doi.org/10.1007/s00167-019-05607-y

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  • DOI: https://doi.org/10.1007/s00167-019-05607-y

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