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How to Manage Intraoperative Contamination

Cheryl Lawing1, Luke Hedrick2, Ashley Startzman1

  • 1Shriners Children's Greenville, Greenville, SC, USA.

Journal of the Pediatric Orthopaedic Society of North America
|February 2, 2026
PubMed

Insights

Maintaining sterile technique is crucial to prevent surgical site infections. This review guides surgeons on managing unexpected sterile breaches during operations to minimize patient infection risk.

Area of Science:

  • Surgical Safety
  • Infection Control
  • Operating Room Management

Background:

  • Sterile technique is vital for preventing surgical site infections (SSIs).
  • Despite adherence to protocols, sterile breaches can occur intraoperatively, posing risks.
  • Examples include drape defects, insect contamination, instrument bioburden, dropped grafts, and faulty wrappers.

Purpose of the Study:

  • To review existing literature and provide guidance for managing intraoperative sterile technique breaches.
  • To assist surgical teams in making informed decisions during unexpected contamination events.

Main Methods:

  • Literature review of available studies on intraoperative sterile breaches.
  • Analysis of decision-making processes in response to contamination events.

Main Results:

  • Pre-incision contamination warrants conservative reprocessing and actions.
  • Post-incision contamination requires risk-benefit assessment, potentially involving flash sterilization or graft decontamination.
  • Vigilance is needed due to limitations in detecting sterile drape and glove defects.
  • Orthopaedic instrumentation bioburden is a common risk factor.
  • Pest identification necessitates culturing and infrastructure assessment.

Conclusions:

  • Prompt and conservative management of sterile breaches is essential.
  • Decision-making for post-incision contamination must balance risks and benefits.
  • Enhanced vigilance and proactive measures are required to mitigate infection risks from sterile breaches.
Keywords:
Bio debris in orthopaedic instrumentationContaminated grafts in orthopaedic surgeryPests in the ORSterile drape integrity

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