Iatrogenic Contamination With a Surgical Helmet System in Orthopedic Surgery.

Area of Science:

• Orthopedic Surgery
• Infection Control
• Microbiology

Background:

• Periprosthetic joint infections are a risk in orthopedic surgery.
• Surgical helmet systems (SHSs) aim to reduce iatrogenic contamination.
• The efficacy of SHSs compared to traditional surgical attire (TSA) remains debated.

Purpose of the Study:

• To compare iatrogenic contamination rates among TSA, SHS, and SHS with delayed ventilation (SHS-DV).
• To identify optimal protocols for SHS use to minimize bacterial contamination during surgery.

Main Methods:

• 180 orthopedic surgical procedures were prospectively enrolled and randomized into three cohorts: TSA, SHS, and SHS-DV.
• Cultures were obtained from forearms, axillae, sternum, and face shields.
• Bacterial contamination rates were calculated and stratified by location and microorganism type.

Main Results:

• Overall positive culture rates were 15% (TSA), 25% (SHS), and 18% (SHS-DV).
• Positive swab culture rates were 6% (TSA), 7% (SHS), and 4% (SHS-DV).
• The SHS-DV cohort demonstrated a lower overall bacterial contamination rate.

Conclusions:

• Bacterial contamination rates were similar between TSA and SHS cohorts.
• Initiating SHS airflow after surgeons are gowned and gloved (SHS-DV) may reduce contamination.
• Treating SHS face shields as contaminated is recommended to minimize iatrogenic contamination.