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Sterility of the personal protection system in total joint arthroplasty
Kenneth A Kearns1, Dan Witmer, Junaid Makda
1The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
Background:
Bacteria shed by operating room personnel is a source of wound contamination and postoperative infections. The personal protection system (PPS) was designed to decrease airborne bacteria and intraoperative contamination in total joint arthroplasty.
Questions/Purposes:
We determined the microbial contamination rate of the PPS and incidence of contamination with key pathogens, Staphylococcus aureus and coagulase-negative staphylococci.
Patients And Methods:
We prospectively evaluated PPS contamination in 61 primary THAs and 41 TKAs. The PPS were assumed to be sterile before opening the packs. The initial culture was taken immediately after the hood was placed over the helmet. Four cultures were collected at the conclusion of the procedure. Plates were examined and colonies were classified according to Gram stain results and biochemical tests. S. aureus was classified as methicillin-resistant or -susceptible.
Results:
At time zero, 22 of 102 cultures isolated an organism, accounting for a contamination rate of 22%. The bacterial contamination rate of the PPS at the conclusion of the procedure was 47% (48 of 102). The relative percentage of the various organisms found was coagulase-negative staphylococci 50%, Micrococcus sp. 20%, methicillin-susceptible S. aureus 11%, and methicillin-resistant S. aureus (MRSA) 1%.
Conclusions:
The external surface of the PPS cannot be assumed to be sterile after its removal from the original packaging. Of all the PPS studied, the potential pathogens coagulase-negative staphylococcus, S. aureus, and MRSA were found in 43%. This study supports the need to change gloves if the PPS is touched or adjusted during the procedure.
Insights
The personal protection system (PPS) used in surgery is often contaminated with bacteria, including Staphylococcus aureus. This highlights the need for sterile protocols and glove changes during procedures to prevent wound contamination and infections.
Area of Science:
- Surgical Infection Prevention
- Microbiology
- Orthopedic Surgery
Background:
- Bacteria shed by operating room personnel contribute to wound contamination and postoperative infections.
- The personal protection system (PPS) aims to reduce airborne bacteria and intraoperative contamination during total joint arthroplasty.
Purpose of the Study:
- To determine the microbial contamination rate of the PPS.
- To assess the incidence of contamination with key pathogens like Staphylococcus aureus and coagulase-negative staphylococci.
Main Methods:
- Prospective evaluation of PPS contamination in 61 primary total hip arthroplasties (THAs) and 41 total knee arthroplasties (TKAs).
- Cultures collected immediately after PPS hood placement and at the procedure's conclusion.
- Organism identification via Gram stain and biochemical tests, with S. aureus classified as methicillin-resistant or susceptible.
Main Results:
- Initial contamination rate at time zero was 22% (22 of 102 cultures).
- Bacterial contamination rate of the PPS increased to 47% (48 of 102) by the procedure's end.
- Coagulase-negative staphylococci (50%) and methicillin-susceptible S. aureus (11%) were prevalent; methicillin-resistant S. aureus (MRSA) was found in 1%.
Conclusions:
- The external surface of the PPS is not sterile after removal from packaging.
- Potential pathogens (coagulase-negative staphylococcus, S. aureus, MRSA) were found on 43% of PPS.
- Reinforces the necessity of changing gloves if the PPS is touched or adjusted during surgery to mitigate infection risk.
