Abstract
BackgroundIn spine surgery, surgical site infection (SSI) is one of the main perioperative complications and is associated with a higher patient morbidity and longer patient hospitalization. Most factors associated with SSI are connected with asepsis during the surgical procedure and thus with contamination of implants and instruments used which can be caused by pre- and intraoperative factors. In this systematic review we evaluate the current literature on these causes and discuss possible solutions to avoid implant and instrument contamination.MethodsA systematic literature search of PubMed addressing implant, instrument and tray contamination in orthopaedic and spinal surgery from 2001 to 2019 was conducted following the PRISMA guidelines. All studies regarding implant and instrument contamination in orthopaedic surgery published in English language were included.ResultsThirty-five studies were eligible for inclusion and were divided into pre- and intraoperative causes for implant and instrument contamination. Multiple studies showed that reprocessing of medical devices for surgery may be insufficient and lead to surgical site contamination. Regarding intraoperative causes, contamination of gloves and gowns as well as contamination via air are the most striking factors contributing to microbial contamination.ConclusionsOur systematic literature review shows that multiple factors can lead to instrument or implant contamination. Intraoperative causes of contamination can be avoided by implementing behavior such as changing gloves right before handling an implant and reducing the instruments’ intraoperative exposure to air. In avoidance of preoperative contamination, there still is a lack of convincing evidence for the use of single-use implants in orthopaedic surgery.
Highlights
In spine surgery, surgical site infection (SSI) is one of the main perioperative complications and is associated with a higher patient morbidity and longer patient hospitalization
The reprocessing of medical products such as surgical instruments or implants by the sterilization processing department is a key process in standard clinical practice and is thought to be essential in the prevention of SSI
The 71 remaining studies were assessed for eligibility
Summary
Surgical site infection (SSI) is one of the main perioperative complications and is associated with a higher patient morbidity and longer patient hospitalization. The reprocessing of medical products such as surgical instruments or implants by the sterilization processing department is a key process in standard clinical practice and is thought to be essential in the prevention of SSI. Since only a small portion of processed implants is used during surgery, these implants are reprocessed multiple times before surgically being implanted in a patient. Even though this is standard clinical practice, little is known about the long-term behavior of reprocessed products especially regarding their contamination. Despite efforts to reduce the risk of contamination during surgery, correct handling of implants and instruments continues to constitute a challenge and thereby a possible threat to patient safety
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