Risk of conjunctival contamination in total joint arthroplasty

This study arose from a concern about the transmission of infection through conjunctival contamination during total joint arthroplasty surgery. A prospective analysis of 110 sets of personal face and eye protective equipment (Sterishields) used for 29 total hip arthroplasties (THA) and 26 total knee arthroplasties (TKA) were examined for macroscopic contamination. In additition, a postal questionnaire regarding the perceived risk of eye contamination and current practice of eye protection used during TKA and THA surgery was sent to 1500 Fellows of the British Orthopaedic Association. All Sterishields demonstrated macroscopic contamination with an average of 203 blood and fat spots. The number of these was significantly higher in the lower half of the Sterishields. Of the 834 useable replies, 48% of respondents did not use adequate eye protection routinely. Twenty-eight percent felt that no eye protection was needed, while 45% felt that the eye protection available compromised their vision and so did not use it. One hundred and seven respondents (13%) reported being aware of eye contamination, while 21 (2.5%) respondents were aware of at least one case of conjunctival infection following contamination. This study demonstrates that there is a high risk of conjunctival contamination with fat and blood in major total joint arthroplasty. The reported use of appropriate eye and face protection in the UK has been shown to be low (52%).