Sterile Setup Table in the Operating Room Is Not So Sterile

Area of Science:

• Orthopedic Surgery
• Microbiology
• Infection Prevention

Background:

• Surgical site infection (SSI) prevention is critical in orthopedic procedures.
• Maintaining an ultraclean operating room environment is essential for minimizing SSIs.
• The sterility of the back table, where instruments are prepared, is a key factor.

Purpose of the Study:

• To evaluate the microbial contamination of back-table setups during total joint arthroplasty.
• To compare the efficacy of traditional culture methods versus next-generation sequencing (NGS) in detecting back-table contamination.

Main Methods:

• A prospective study involving 52 patients undergoing primary total joint arthroplasty.
• Collection of 104 back-table swabs and 104 air swabs at the conclusion of surgery.
• Analysis of swabs using both standard culture and next-generation sequencing (NGS).

Main Results:

• 12.5% of back-table swabs yielded microbial growth (13/104).
• Culture identified 7 organisms, while NGS identified 6; no overlap was observed between methods for back-table swabs.
• Air swabs also showed contamination (10.6%), with some instances where both methods detected pathogens.

Conclusions:

• The sterile field, including the instrument back table, is not always sterile and can harbor pathogens.
• Current methods may not fully capture the microbial load, suggesting potential for underestimation of contamination.
• Findings underscore the importance of rigorous sterility maintenance and potentially enhanced detection methods to prevent SSIs.