Prevalence of bacterial burden on macroscopic contaminants of orthopaedic surgical instruments following sterilization.

BACKGROUND: Macroscopic contamination of orthopaedic instruments with particulates, including cortical bone and polymethyl methacrylate (PMMA) bone cement, that have previously undergone pre-operative sterilization is frequently encountered peri- or intraoperatively, calling into question the sterility of such instruments. AIM: To determine if macroscopic contaminants of orthopaedic surgical instrumentation maintain a bacterial burden following sterile processing, and to determine the most commonly contaminated instruments and the most common contaminants. METHODS: Macroscopic contaminants in orthopaedic instrument trays were collected prospectively at a single tertiary referral centre over a 6-month period from August 2021 to May 2022. When identified, these specimens were swabbed and plated on sheep blood agar. All specimens were incubated at 37 °C for 14 days, and inspected visually for colony formation. When bacterial colony formation was identified, samples were sent for species identification. RESULTS: In total, 33 contaminants were tested, and only one contaminant was found to be growing bacterial colonies (Corynebacterium sp.). The items most commonly found to have macroscopic contamination were surgical trays (N=9) and cannulated drills (N=7). The identifiable contaminants were bone (N=10), PMMA bone cement (N=4) and hair (N=4). Eleven macroscopic contaminants were not identifiable. CONCLUSION: This study found that 97% of macroscopic orthopaedic surgical instrument contaminants that underwent sterile processing did not possess a bacterial burden. Contaminants discovered during a procedure are likely to be sterile, and do not pose a substantially increased risk of infection to a patient.

Operative efficiency: comparison of methods to optimize the use of chlorhexidine gluconate applicators.

BACKGROUND: With the high costs of operating room time, minimizing potential causes of time waste is financially beneficial to surgeons and hospitals. The time needed to activate a chlorhexidine gluconate surgical solution applicator presents an opportunity for optimization. Many techniques are employed to expedite the process, but there have been no studies comparing these techniques. AIM: To determine the most efficient method for utilizing a chlorhexidine gluconate surgical prep applicator. METHODS: Six techniques were tested to determine which caused the sponge of a Chloraprep™ applicator to become saturated quickest. These were a single squeeze (control), up-and-down shaking, side-to-side shaking, pressing the sponge on a surface (dab), pressing with cotton swabs (poke), and continuously squeezing the lever of the applicator. The time between the internal glass breaking in the applicator to the time of sponge saturation with solution was measured for each technique. Times were then compared to determine which technique best expedited the process. FINDINGS: The side-to-side shake, up-and-down shake, and 'dab' techniques were each significantly faster than the control group. Side-to-side shaking had the fastest time to sponge saturation on average. The average difference in time to saturation between the side-to-side shake technique and the 'poke' technique may be as much as 27.5 s. CONCLUSIONS: Utilization of the side-to-side shake technique, as well as the up-and-down shake and 'dab' techniques, significantly expedite the time it takes to use a chlorhexidine gluconate applicator. The time savings from employing these techniques could result in significant financial benefits.