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Routes of infection. A study of using "tracer particles" in the orthopedic operating room
Abstract:
Wound irrigates and tissue samples were cultured from clean orthopedic wounds at the conclusion of 280 orthopedic operations. The surgeons used a laminar flow unit and took extra precautions against wound contamination although personnel exhaust systems were not used. It was possible to culture residual organisms but difficult to trace the source of these by bacteriological methods. Artificial or "tracer" particles which could be applied to patient or surgeon were retrieved from the wound and suitably stained. Using albumin microspheres it was possible to identify and differentiate "patient-derived particles" from "surgeon-derived particles" in the majority of all wounds. Contamination from the surgeon was significant even under near optimum operating room conditions. These techniques are useful for development of control measures for residual wound contamination in orthopedic operating rooms.
Insights
Surgeons significantly contaminate orthopedic surgical wounds even with precautions. Albumin microspheres traced contamination sources, revealing surgeon-derived particles in most wounds, aiding control measure development.
Area of Science:
- Orthopedic Surgery
- Infection Control
- Microbiology
Background:
- Orthopedic surgical site infections (SSIs) remain a concern despite sterile techniques.
- Identifying sources of residual microbial contamination in operating rooms is challenging.
- Bacteriological methods struggle to pinpoint the origin of wound contamination.
Purpose of the Study:
- To develop and validate a method for tracing the source of wound contamination in orthopedic surgery.
- To quantify contamination originating from the patient versus the surgical team.
- To inform the development of improved operating room contamination control strategies.
Main Methods:
- Culturing wound irrigates and tissue samples from 280 orthopedic operations.
- Utilizing artificial tracer particles (albumin microspheres) applied to patients and surgeons.
- Retrieving, staining, and analyzing tracer particles from surgical wounds to differentiate sources.
Main Results:
- Residual organisms were cultured, but their sources were difficult to identify via traditional methods.
- Albumin microspheres successfully differentiated patient-derived from surgeon-derived particles in most wounds.
- Significant contamination originated from the surgeon, even under optimal operating room conditions.
Conclusions:
- Surgeon-derived contamination is a significant factor in orthopedic surgical wounds.
- Albumin microsphere tracing is an effective technique for identifying contamination sources.
- These findings support the development of targeted interventions to reduce operating room contamination.