Risk of conjunctival contamination in total joint arthroplasty

Area of Science:

• Orthopaedic Surgery
• Infection Control
• Ophthalmology

Background:

• Conjunctival contamination poses a risk of infection during total joint arthroplasty.
• Concerns exist regarding the transmission of pathogens via eye exposure in surgical settings.

Purpose of the Study:

• To assess the incidence of conjunctival contamination during total hip arthroplasty (THA) and total knee arthroplasty (TKA).
• To evaluate the current practices and perceptions of eye protection use among orthopaedic surgeons in the UK.

Main Methods:

• Prospective analysis of 110 sets of eye protective equipment (Sterishields) for macroscopic contamination.
• Postal questionnaire survey of 1500 British Orthopaedic Association Fellows on eye protection practices and perceived risks.

Main Results:

• All Sterishields showed significant contamination (average 203 blood/fat spots), more in the lower half.
• Only 52% of surgeons reported routine adequate eye protection use.
• 48% did not use adequate eye protection; 28% felt none was needed, 45% found it impaired vision.
• 13% were aware of eye contamination, 2.5% of conjunctival infections post-contamination.

Conclusions:

• High risk of conjunctival contamination with blood and fat during major joint arthroplasty.
• Low reported use of adequate eye and face protection in the UK orthopaedic community.
• Inadequate eye protection practices may contribute to surgical site infections.