Evaluating the impact of povidone-iodine irrigation on microbial contamination in reverse total shoulder arthroplasty
Enrico Bellato1,2, Filippo Castoldi1,2, Francesca Menotti3
1Department of Surgical Sciences, University of Turin, Turin, Italy.
Aims:
One of the primary causes of periprosthetic joint infection (PJI) in reverse total shoulder arthroplasty (RTSA) is intraoperative contamination. This study aimed to evaluate the effectiveness of povidone-iodine irrigation in reducing bacterial contamination of the surgical field during primary RTSA.
Methods:
A total of 65 patients were prospectively included (mean age 74.1 years (SD 7.9); 43 female, 22 male). Patients with fractures, osteonecrosis, tumours, or previous surgical treatment failures, as well as those who had received recent antibiotic or infiltrative therapy, were excluded. At the end of the surgery, six different samples were collected. The first set of three samples - one swab from the glenosphere, one from the humeral component, and one from the periprosthetic tissue - were obtained before irrigation (using a 0.35% povidone-iodine solution diluted with saline). The second set of three samples was taken from the same sites, but after irrigation. The six samples were processed to perform both qualitative and quantitative assessments of the microbial load.
Results:
Cutibacterium acnes was the only anaerobic strain recovered, found in both swabs and periprosthetic tissues, while the aerobic flora included gram-positive bacteria - mainly coagulase-negative staphylococci (CoNS) - and few gram-negative species. Povidone-iodine irrigation significantly reduced both the positivity rates and bacterial loads of C. acnes and CoNS. C. acnes loads decreased from ~10³ to ~10² colony-forming units (CFUs)/ml, and CoNS loads decreased from ~10¹ to nearly zero CFUs/ml. The time to culture positivity for C. acnes depended on the bacterial load, ranging from three to five days (≥ 10³ CFUs/ml) to > six days (≤ 10² CFUs/ml), while the aerobes grew faster (one to four days). Higher C. acnes positivity and loads were associated with male sex and the use of cuff tear arthropathy as a surgical indication.
Conclusion:
Intraoperative irrigation with povidone-iodine is significantly effective in reducing bacterial contamination rates during RTSA surgery, despite C. acnes being less susceptible than CoNS.
Insights
Povidone-iodine irrigation effectively reduces bacterial contamination during reverse total shoulder arthroplasty (RTSA). This method significantly lowers bacterial loads, including Cutibacterium acnes, aiding in preventing periprosthetic joint infection (PJI).
Area of Science:
- Orthopedic Surgery
- Infectious Disease Control
- Biomedical Research
Background:
- Periprosthetic joint infection (PJI) is a significant complication following reverse total shoulder arthroplasty (RTSA).
- Intraoperative contamination is a primary cause of PJI in RTSA procedures.
- Effective methods to reduce surgical field contamination are crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of povidone-iodine irrigation in minimizing bacterial contamination during primary RTSA.
- To assess the impact of povidone-iodine on specific bacterial species commonly found in the surgical field.
- To quantify the reduction in microbial load achieved by povidone-iodine irrigation.
Main Methods:
- Prospective study including 65 patients undergoing primary RTSA.
- Collection of six bacterial samples (three before and three after irrigation) from implant components and periprosthetic tissue.
- Qualitative and quantitative analysis of microbial load, focusing on Cutibacterium acnes and aerobic bacteria (CoNS).
Main Results:
- Povidone-iodine irrigation significantly reduced the positivity rates and bacterial loads of Cutibacterium acnes and coagulase-negative staphylococci (CoNS).
- Bacterial loads of C. acnes decreased from approximately 10³ to 10² CFU/ml, and CoNS loads decreased from approximately 10¹ to nearly zero CFU/ml.
- Higher C. acnes positivity and loads were associated with male sex and cuff tear arthropathy indication.
Conclusions:
- Intraoperative povidone-iodine irrigation is a highly effective strategy for reducing bacterial contamination in RTSA.
- While povidone-iodine demonstrates significant efficacy, Cutibacterium acnes showed less susceptibility compared to CoNS.
- The findings support the use of povidone-iodine irrigation as an adjunct measure to prevent PJI in RTSA.
Related Concept Videos
01:23Hand hygiene
Hand washing...
01:18Surface Membrane Barriers
The outer layer of the skin, the epidermis, is a robust barrier comprising layers of closely packed keratinized cells. This dense arrangement prevents microbes from penetrating the body. The periodic shedding of epidermal cells...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:30Cleaning, Sterilization, and Disinfection
Cleaning
The cleaning process usually involves using water with detergents or enzymatic cleaner and removing foreign material from objects and surfaces, including organic material such as body fluids or inorganic material like soil. Cleaning is performed before high-level disinfection and sterilization because foreign materials on the cover of the devices interfere with process...