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Contamination of the Mini C-Arm During Foot and Ankle Surgery
Kaveh Momenzadeh1,2, Caroline Williams1,3, Natalia Czerwonka1
1Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Background:
Many orthopedic surgeries utilize intraoperative fluoroscopy. The mini C-arm is an advantageous device as it can be easily used without the need for a dedicated radiology technician. However, there are concerns that the mini C-arm may represent a potential source of contamination and subsequent postoperative infection. Previous investigations of standard C-arm drapes have shown high rates of contamination. Similar contamination rates would be even more concerning for the mini C-arm as it requires physically maneuvering the machine. This study aimed to determine the rate of mini C-arm drape contamination and identify high-risk areas.
Methods:
Fifty foot and ankle surgeries requiring the use of mini C-arm fluoroscopy were included. Eight locations on the mini C-arm drape were sampled at the conclusion of each procedure. Culture Q-swabs were used for sampling defined locations. Swab samples were then assessed for bacterial growth on a 5% blood agar plate using a semiquantitative technique.
Results:
In 70% of surgical cases, contamination was observed in at least 1 location. Six of the 8 evaluated locations were found to have significantly higher contamination in comparison with their corresponding negative controls (Mann-Whitney U test, P < .05). The "outer portion of the upper arm" (location 1) exhibited bacteria growth in 26% (P < .0001) of cases. The "superior portion of the x-ray source" (location 2) exhibited growth in 30% (P < .0001) of cases. These were the highest-risk areas for contamination and were both significantly more likely to be involved than the "inferior portion of the x-ray source" and "superior portion of the beam receiver," locations 4 and 5, respectively. Fourteen percent (7/50) C-arm cases and 1.72% (1/58) Achilles tendon surgery control cases developed surgical site infection (P = .0234; OR, 9.27).
Conclusion:
Bacterial contamination of the mini C-arm drape was found to be common after foot and ankle procedures. Contamination was more prevalent on the outer ring areas of the C-arm, both at the emitter and receiver.
Level Of Evidence:
Level III, prospective cohort study.
Insights
Mini C-arm drape contamination is common in orthopedic foot and ankle surgeries, with high-risk areas identified on the outer portions of the device. This highlights potential infection risks that require further investigation and mitigation strategies.
Area of Science:
- Orthopedic Surgery
- Infection Control
- Medical Device Contamination
Background:
- Intraoperative fluoroscopy is essential in orthopedic surgery.
- Mini C-arms offer convenience but raise concerns about contamination and infection.
- Standard C-arm drapes have shown high contamination rates, prompting investigation into mini C-arms.
Purpose of the Study:
- To determine the rate of mini C-arm drape contamination in foot and ankle surgeries.
- To identify specific high-risk areas on the mini C-arm drape for bacterial contamination.
Main Methods:
- Prospective cohort study of 50 foot and ankle surgeries using mini C-arm fluoroscopy.
- Bacterial sampling from eight defined locations on the mini C-arm drape post-procedure.
- Semiquantitative assessment of bacterial growth on blood agar plates.
Main Results:
- Seventy percent of surgical cases showed contamination on at least one drape location.
- Six of eight sampled locations had significantly higher contamination than negative controls.
- The outer portions of the x-ray source and beam receiver were identified as high-risk areas.
Conclusions:
- Bacterial contamination of mini C-arm drapes is prevalent after foot and ankle procedures.
- Outer ring areas of the C-arm, including emitter and receiver, are most susceptible to contamination.
- Findings underscore the need for enhanced sterile techniques when using mini C-arms.
