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Sterility of Miniature C-arm Fluoroscopy in Hand and Upper Extremity Surgery
James P Hovis1, Stephanie N Moore-Lotridge1, Ashton Mansour1
1Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Abstract:
Previous studies have demonstrated that sterile equipment is frequently contaminated intraoperatively, yet the incidence of miniature c-arm (MCA) contamination in hand and upper extremity surgery is unclear. To examine this incidence, a prospective study of MCA sterility in hand and upper extremity cases was performed in a hospital main operating room (MOR) ( n = 13) or an ambulatory surgery center operating room (AOR) ( n = 16) at a single tertiary care center. Case length, MCA usage parameters, and sterility of the MCA through the case were examined. We found that MOR surgical times trended toward significance ( p = 0.055) and that MOR MCAs had significantly more contamination prior to draping than AOR MCAs ( p < 0.001). In MORs and AORs, 46.2 and 37.5% of MCAs respectively were contaminated intraoperatively. In MORs and AORs, 85.7 and 80% of noncontaminated cases, respectively, used the above hand- table technique, while 50 and 83.3% of contaminated MOR and AOR cases, respectively, used a below hand-table technique. Similar CPT codes were noted in both settings. Thus, a high-rate of MCA intraoperative contamination occurs in both settings. MCA placement below the hand-table may impact intraoperative contamination, even to distant MCA areas. Regular sterilization of equipment and awareness of these possible risk factors could lower bacterial burden.
Insights
Miniature c-arm (MCA) contamination is common during hand and upper extremity surgery. Proper equipment sterilization and awareness of placement techniques, like avoiding positioning below the hand-table, can reduce bacterial contamination.
Area of Science:
- Surgical Safety
- Infection Control
- Orthopedic Surgery
Background:
- Sterile equipment contamination during surgery is a known issue.
- The intraoperative contamination rate of miniature c-arms (MCAs) in hand and upper extremity surgery remains understudied.
Purpose of the Study:
- To prospectively evaluate the incidence and risk factors associated with miniature c-arm (MCA) contamination in hand and upper extremity surgeries.
- To compare MCA contamination rates between hospital main operating rooms (MORs) and ambulatory surgery center operating rooms (AORs).
Main Methods:
- A prospective study was conducted in a tertiary care center, observing MCA sterility during hand and upper extremity procedures.
- Data collected included operating room type (MOR vs. AOR), surgical case length, MCA usage parameters, and intraoperative MCA contamination.
- Statistical analysis was performed to compare contamination rates and identify potential risk factors.
Main Results:
- Miniature c-arm (MCA) contamination occurred intraoperatively in 46.2% of cases in MORs and 37.5% in AORs.
- MCAs in MORs showed significantly higher contamination rates prior to draping compared to AORs.
- A below hand-table MCA placement technique was associated with a higher incidence of contamination in both MOR and AOR settings.
Conclusions:
- A high rate of intraoperative miniature c-arm (MCA) contamination is prevalent in both hospital and ambulatory surgical settings for hand and upper extremity procedures.
- MCA placement technique, particularly positioning below the hand-table, may significantly increase the risk of contamination.
- Implementing regular sterilization protocols and increasing awareness of placement-related risk factors are crucial for reducing bacterial burden.
