Should we be prepping the foot? Stockinette use and drape contamination during hip arthroplasty: An experimental study.

Abstract

Meticulous prepping and draping of the surgical field is paramount to reduce the risk of infection. A consistent technique for draping for hip arthroplasty is not well established. One technique for preparing the operative field utilises a sterile stockinette over an unprepped foot. This study aims to assess surgical site contamination when draping for hip arthroplasty without disinfecting the foot. Ultraviolet (UV) fluorescent powder was used as a surrogate for microbial presence on the foot. Powder was applied to a volunteer's foot to a level where antibacterial prep would stop. The leg was then draped according to three methods; directly with stockinette only, wrapping the foot without using an adhesive seal followed by stockinette, and wrapping the foot with the adhesive seal followed by stockinette. Proximal spread of powder after draping was assessed with UV light. Contamination of the sterile field was found with all draping methods. Spread was particularly noted in the groin, posterior to the thigh and distal to mid-thigh. Wrapping the foot in a small drape without the adhesive seal prior to stockinette application was associated with significantly greater contamination when compared with use of the seal (p= 0.004). Routine formal prepping of the foot during hip arthroplasty is recommended to reduce the risk of surgical site contamination. Surgeons who select not to prep the foot should make use of a small drape with occlusive, adhesive seal prior to stockinette application and consider applying a further U drape to the hip.