Abstract
Surgical site infection is a relatively common and devastating complication following pediatric orthopedic surgery. Many infections have been determined to be the result of settled airborne particles on surgical equipment and the sterile field. Fiberglass casts are commonly used orthopedic fixation devices before and after surgery; however, fiberglass casting material is expelled during the removal process and represents an uninvestigated area for the possibility of cast saw dust as a source of airborne bacterial contamination in an operating room setting. This study evaluates the prevalence and distribution of microbiota on 90 pediatric casts by collecting and culturing fiberglass cast material from 90 pediatric casts. Bacterial identification was performed using a Bruker Biotyper Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry device. 81 out of 90 casts (90%) showed evidence of microbial contamination. Isolated species were very diverse and ranged from normal skin flora to opportunistic pathogens. The 5 most commonly isolated organisms were Acinetobacter pittii, Enterobacter cloacae, Micrococcus luteus, Staphylococcus epidermidis, and Staphylococcus hominis. Further investigation is required to determine if casting material is truly a cause of surgical site infection.
Highlights
Surgical site infections (SSI) are an incredibly costly and damaging complication following pediatric orthopedic surgical procedures
We are unaware of any other studies that have investigated the microbial load or diversity of fiberglass casts nor that have investigated the possibility that operative suite cast removal could present a preventable cause of surgical site infections in pediatric orthopedic surgery
16.4% of samples were considered to be normal skin flora, while other bacteria identified have been implicated in sepsis, meningitis, pneumonia, multidrug resistance and surgical site infections [10, 11]
Summary
Surgical site infections (SSI) are an incredibly costly and damaging complication following pediatric orthopedic surgical procedures. Studies suggest that the rate of infection in children is lower than the rate in adults; infections are still a relatively common complication following orthopedic surgery a ecting up to 2.9% of children a er fracture xation with hardware [2]. In addition to decreasing patient’s wellbeing and introducing signi cant morbidity, SSIs have been demonstrated to increase average length of stay from 5 to 13 days, increase cost of stay by thousands of dollars and signi cantly increase risk of post-procedural mortality [3, 4]. Given that SSIs are preventable complications, there has been signi cant research investigating how to minimize their occurence. It has been demonstrated that intraoperative events, behaviour, and protocol have a signi cantly greater e ect on infection than patient-related measures [5]. Pre-surgical scrub, and surgical site preparation have all played a signi cant role in decreasing surgical site
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