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Published on: December 3, 2017
Risk of Contamination in Assembled vs Disassembled Instruments in Hip Arthroplasty Surgery
Ryan R Mayer1, S Samuel Bederman2, Vincent M Colin1
1Department of Orthopaedic Surgery, University of California, Irvine, Orange, California.
Background:
Periprosthetic joint infection (PJI) is one of the most common causes of revision total hip arthroplasty (THA) and associated with higher costs, prolonged pain, and worse clinical outcomes. Many factors have been linked to increased infection rates, one being the operative equipment and instrumentation used during the surgical procedure. With few arthroplasty instruments designed for complete disassembly and increasingly complex instrument designs, this study seeks to understand the effect that instrument disassembly plays on infection using disassembled and assembled standard femoral broach handles (BHs).
Methods:
Two BHs, not designed for disassembly, were modified and then contaminated in the disassembled state with Geobacillus stearothermophilus vegetative-form bacteria and spores. Using both flash and standard sterilization cycles, the BHs were steam sterilized in the disassembled or assembled state and then analyzed for remaining bacteria and spores.
Results:
At all target locations after either a flash sterilization cycle or a standard sterilization cycle, complete eradication of both the vegetative-form and spore-form of G stearothermophilus was achieved.
Conclusion:
This study demonstrates that adequate decontamination of the tested BHs can be achieved after steam sterilization in either the disassembled or assembled state, without an increased risk of infection transmission.
Insights
Steam sterilization effectively decontaminates both assembled and disassembled surgical instruments, like femoral broach handles (BHs), reducing the risk of periprosthetic joint infection (PJI) transmission.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Control
- Biomedical Engineering
Background:
- Periprosthetic joint infection (PJI) is a significant complication of total hip arthroplasty (THA), leading to adverse patient outcomes and increased healthcare costs.
- Surgical instrumentation and equipment are potential vectors for PJI, particularly with complex designs that hinder thorough cleaning and sterilization.
- The impact of surgical instrument disassembly on infection risk during sterilization remains an area requiring further investigation.
Purpose of the Study:
- To evaluate the efficacy of steam sterilization in eradicating bacterial contamination from disassembled versus assembled femoral broach handles (BHs).
- To determine if instrument disassembly influences the effectiveness of sterilization in preventing infection transmission during THA procedures.
Main Methods:
- Two standard femoral broach handles (BHs), modified for disassembly, were contaminated with Geobacillus stearothermophilus (vegetative and spore forms).
- BHs were subjected to steam sterilization using both flash and standard cycles in either a disassembled or assembled state.
- Post-sterilization analysis assessed the presence of remaining bacteria and spores at various locations on the BHs.
Main Results:
- Complete eradication of both vegetative and spore forms of G. stearothermophilus was achieved across all tested locations.
- Effective decontamination was demonstrated irrespective of whether flash or standard sterilization cycles were employed.
- The sterilization process successfully eliminated bacterial contamination in both disassembled and assembled BHs.
Conclusions:
- Steam sterilization is highly effective in decontaminating modified femoral broach handles (BHs), regardless of their assembled or disassembled state.
- Instrument disassembly does not appear to increase the risk of infection transmission when standard sterilization protocols are followed.
- These findings support the potential for effective sterilization of complex surgical instruments, contributing to PJI prevention strategies.
