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What Is the Duration of Irrigation? An In Vitro Study of the Minimum Exposure Time to Eradicate Bacteria With

Zachary K Christopher1, Christine Phuong Tran2, Brent L Vernon2

  • 1Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ.

The Journal of Arthroplasty
|November 6, 2021
PubMed
Abstract

Insights

Povidone-iodine, sodium hypochlorite, and acetic acid effectively eliminate common joint infection bacteria within 90 seconds. Povidone-iodine may offer the fastest eradication for Staphylococcus aureus, Staphylococcus epidermidis, and Cutibacterium acnes.

Area of Science:

  • Orthopedic Surgery
  • Infectious Disease
  • Microbiology

Background:

  • Arthroplasty surgeons use antiseptic irrigation to prevent bacterial colonization and reduce postoperative infections.
  • The minimum effective irrigation time to eliminate key microbes in periprosthetic joint infection is not well-established.
  • This study aimed to determine the minimum exposure time for common antiseptics against relevant bacteria.

Purpose of the Study:

  • To determine the minimum effective antiseptic irrigation time against Staphylococcus aureus, Staphylococcus epidermidis, and Cutibacterium acnes.
  • To compare the efficacy of povidone-iodine, chlorhexidine, sodium hypochlorite, polyhexamethylene biguanide, and acetic acid solutions.
  • To inform optimal irrigation protocols for primary total joint arthroplasty.

Main Methods:

  • Bacterial cultures of S. aureus, S. epidermidis, and C. acnes were exposed to five antiseptic solutions at specific concentrations.
  • Exposure times included 15, 30, 60, 90, and 120 seconds, performed in triplicate.
  • Bacterial growth was quantified using the drop plate method; failure to eradicate all bacteria defined "not effective" at a given time point.

Main Results:

  • Povidone-iodine (0.35%), sodium hypochlorite (0.5%), and acetic acid eradicated all tested bacteria within 90 seconds.
  • These three solutions showed efficacy as early as 15 seconds for specific bacteria (e.g., S. aureus with povidone-iodine).
  • Polyhexamethylene biguanide required 90-120 seconds, while 0.05% chlorhexidine was ineffective against S. aureus and C. acnes within 120 seconds.

Conclusions:

  • Most tested antiseptic solutions effectively eradicated bacteria within two minutes, except for chlorhexidine.
  • Povidone-iodine demonstrated the potential for the shortest effective treatment duration.
  • Findings suggest optimized irrigation times can enhance infection prevention in primary total joint arthroplasty.
Keywords:
antiseptic solutionsarthroplastybacteriaexposure timeirrigationprevention

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