Intraoperative Contamination Research Articles

Gentamicin for prevention of intraoperative mesh contamination: demonstration of high bactericide effect (in vitro) and low systemic bioavailability (in vivo).

Mesh infection is a severe complication after incisional hernia repair and occurs in 1-3% of all open mesh implantations. For this reason, topical antimicrobial agent applied directly to the mesh is often used procedure. So far, however, this procedure lacks a scientific basis. Two different meshes (Parietex™, Covidien; Ultrapro™, Ethicon Johnson & Johnson) were incubated with increasing amounts of three different Staphylococcus aureus strains (ATCC 25923; Mu50; ST239) with or without gentamicin and growth ability were determined in vitro. To further address the question of the systemic impact of topic gentamicin, serum levels were analyzed 6 and 24h after implantation of gentamicin-impregnated multifilament meshes in 19 patients. None of the gentamicin-impregnated meshes showed any bacterial growth in vitro. This effect was independent of the mesh type for all the tested S. aureus strains. In the clinical setting, serum gentamicin levels 6h after implantation of the gentamicin-impregnated meshes were below the through-level (range 0.4-2.9mg/l, mean 1.2±0.7mg/l). After 24h the gentamicin serum levels in all patients had declined 90-65% of the 6h values. Local application of gentamicin to meshes can completely prevent the growth of even gentamicin-resistant S. aureus strains in vitro. The systemic relevance of gentamicin in the clinical controls showed to be very low, without reaching therapeutic concentrations.

Evidence is Inconclusive that Forcedair Warming Devices Increase Surgical Site Contamination or Infection

The greatest degree of heat loss in surgery is during the first hour after induction of general anesthesia. Intraoperative hypothermia poses great risks for the patients and their recovery. The use of forced air warming devices has been well studied and shown to maintain patient normothermia. There is concern that forced air warming disrupts operating room airflow and contaminates the sterile field leading to surgical site infections. A literature search was performed using Embase, Web of Science, Clinical Key and Nursing at Ovid Joanna Briggs Institute (JBI).Five articles were found comparing the contamination risk of forced air warming with other warming technologies. The synthesis review found insufficient evidence to suggest delayed or discontinued use of forced air warming. The studies’ lack of data showing patient surgical site contamination and inability to conclude that the forced air warming devices actually caused surgical site infections due to intraoperative contamination do not support a change to clinical practice. As the greatest amount of patient heat loss is during the first hour of anesthesia, the use of forced air warming devices at this time is supported as opposed to delaying use due to unsupported concerns of surgical site contamination.

Risk factors associated with incisional surgical site infection in colorectal cancer surgery with primary anastomosis

To investigate the incidence of surgical site infection (SSI) and risk factors in colorectal cancer surgery patients. Between October 2003 and October 2013, 1 381 consecutive patients with colorectal cancer managed surgically with primary anastomosis were included in the study. There were 762 male and 619 female patients with mean body mass index (BMI) was (27.7 ± 3.7) kg/m², aged from 20 to 90 years with a median of 67 years. Patients undergoing emergency surgery and requiring stoma creation were excluded. The patients' characteristics, surgical conditions and prognosis were recorded. Univariate and multiple logistic regression analysis were used to identify any variable predictive factors of SSI. One hundred twenty-six (9.12%) cases developed incisional SSI. The occurrence time for SSI was from 2 to 20 days, mean (6.7 ± 2.9) days. According to multivariable logistic regression analysis, BMI (OR = 1.058, P = 0.030), intraoperative contamination (OR = 10.549, P = 0.000) and open operation as compared with a laparoscopic procedure (OR = 2.111, P = 0.001) were significant independent predictors of incisional SSI. There was a significant decrease in incisional SSI in wound protectors group (OR = 1.646, P = 0.012). BMI and intraoperative contamination are independent predictors of incisional SSI, and wound protectors and laparoscopic surgery are associated with a lower incidence of incisional SSI following colorectal cancer surgery.

Infection after primary total hip arthroplasty.

The number of primary total hip arthroplasties (THAs) performed in the United States each year continues to climb, as does the incidence of infectious complications. The changing profile of antibiotic-resistant bacteria has made preventing and treating primary THA infections increasingly complex. The goal of this review was to summarize (1) the published data concerning the risk of surgical site infection (SSI) after primary THA by type of bacteria and (2) the effect of potentially modifying factors. The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, EMBASE, Web of Science, and PubMed were searched. Studies dated between 2001 and 2011 examining primary THA in adults were included. Meta-analysis of the collected data was performed. The pooled SSI rate was 2.5% (95% confidence interval [Cl], 1.4%-4.4%; P<.001; n=28,883). The pooled deep prosthetic joint infection (PJI) rate was 0.9% (95% Cl, 0.4%-2.2%; P<.001; n=28,883). The pooled rate of methicillin-resistant Staphylococcus aureus SSI was 0.5% (95% Cl, 0.2%-1.5%; P<.001; n=26,703). This is approximately 20% of all SSI cases. The pooled rate of intraoperative bacterial wound contamination was 16.9% (95% Cl, 6.6%-36.8%; P=.003; n=2180). All these results had significant heterogeneity. The postoperative risk of SSI was significantly associated with intraoperative bacterial surgical wound contamination (pooled rate ratio, 2.5; 95% Cl, 1.4%-4.6%; P=.001; n=19,049).

Bacterial contamination of the wound during primary total hip and knee replacement

Background and purpose — Previous work has shown that despite preventive measures, intraoperative contamination of joint replacements is still common, although most of these patients seem to do well in follow-up of up to 5 years. We analyzed the prevalence and bacteriology of intraoperative contamination of primary joint replacement and assessed whether its presence is related to periprosthetic joint infection (PJI) on long-term follow-up.Patients and methods — 49 primary total hip replacements (THRs) and 41 total knee replacements (TKRs) performed between 1990 and 1991 were included in the study. 4 bacterial swabs were collected intraoperatively during each procedure. Patients were followed up for joint-related complications until March 2011.Results — 19 of 49 THRs and 22 of 41 TKRs had at least 1 positive culture. Coagulase-negative staphylococci and Staphylococcus aureus were the most common organisms, contaminating 28 and 9 operations respectively. Where information was available, bacteria from 27 of 29 contaminated operations were susceptible to the prophylactic antibiotic administered. 13% of samples gathered before 130 min of surgery were contaminated, as compared to 35% collected after that time. 2 infections were diagnosed, both in TKRs. 1 of them may have been related to intraoperative contamination.Interpretation — Intraoperative contamination was common but few infections occurred, possibly due to the effect of prophylactic antibiotics. The rate of contamination was higher with longer duration of surgery. It appears that positive results from intraoperative swabs do not predict the occurrence of PJI.

Glove and Gown Effects on Intraoperative Bacterial Contamination

Experiments were performed to determine the risk of bacterial contamination associated with changing outer gloves and using disposable spunlace paper versus reusable cloth gowns. Despite decades of research, there remains a lack of consensus regarding certain aspects of optimal aseptic technique including outer glove exchange while double-gloving and surgical gown type selection. In an initial glove study, 102 surgical team members were randomized to exchange or retain outer gloves 1 hour into clean orthopedic procedures; cultures were obtained 15 minutes later from the palm of the surgeon's dominant gloved hand and from the surgical gown sleeve. Surgical gown type selection was recorded. A laboratory strike-through study investigating bacterial transmission through cloth and paper gowns was performed with coagulase-negative staphylococci. In a follow-up glove study, 251 surgical team members, all wearing paper gowns, were randomized as in the first glove study. Glove study 1 revealed 4-fold higher levels of baseline bacterial contamination (31% vs 7%) on the sleeve of surgical team members wearing cloth gowns than those using paper gowns [odds ratio (95% confidence interval): 4.64 (1.72-12.53); P = 0.0016]. The bacterial strike-through study revealed that 26 of 27 cloth gowns allowed bacterial transmission through the material compared with 0 of 27 paper gowns (P < 0.001). In glove study 2, surgeons retaining outer gloves 1 hour into the case had a subsequent positive glove contamination rate of 23% compared with 13% among surgeons exchanging their original outer glove [odds ratio (95% confidence interval): 1.97 (1.02-3.80); P = 0.0419]. Paper gowns demonstrated less bacterial transmission in the laboratory and lower rates of contamination in the operating room. Disposable paper gowns are recommended for all surgical cases, especially those involving implants, because of the heightened risk of infection. Outer glove exchange just before handling implant materials is also recommended to minimize intraoperative contamination.

The role of microparticles in the transfer of pathogenic microflora in the air of orthopaedic operating rooms (review of literature)

The authors have analysed scientific publications, which deal with study of the role of microparticles with different size, suspended in the air of operating rooms, in transfer of pathogenic and opportunistic microflora. The authors believe that introduction of air ultrafiltration in operating rooms can become a measure for preventing intraoperative contamination of operative wounds, surgical gloves and instruments with a resultant decrease in the rate of postoperative infectious complications.

Periprothetische Infektion nach Hüftendoprothetik

Periprosthetic infections (PPI) represent one of the most complex complications in arthroplasty concerning both, diagnosis and therapy. The incidence of PPI of the hip is approximately 1 % after primary procedures and 4 % after revision surgery. About two thirds of PPIs occur via intraoperative contamination and the remaining PPIs are acquired by hematogenous seeding. This article presents an overview of up to date evidence-based diagnostics and therapy of PPI of the hip with the establishment of a clear algorithm. A selective literature search was carried out with the inclusion of own work. A PPI must be actively excluded in cases of a painful prosthesis or signs of loosening within the first years after implantation. Measurement of C-reactive protein (CRP) can be normal especially in cases of chronic (low grade) PPI and cannot be used as an exclusion criterion. The standard diagnostic procedure includes preoperative joint aspiration with culture and leukocyte counts as well as culture and histology of periprosthetic tissue. Imaging techniques, such as magnetic resonance imaging (MRI) and scintigraphy are of inferior significance. Newer methods, such as sonication of removed implants have revolutionized the diagnostics and several cases which had previously been considered aseptic loosening failures have now been reclassified as PPI. Essential parameters for the treatment algorithm are maturity of the biofilm, stability of the prosthesis, the causative organism and the state of the soft tissue. Retention of the prosthesis can only be considered when the biofilm is still immature (acute PPI). In chronic (low grade) PPI eradication of the infection can only be achieved by exchanging the prosthesis. This has to be performed either as a one-stage procedure or as a two-stage exchange with a short (2-4weeks) or a long (> 6weeks) interval. Biofilm active antibiotics play an essential role in the treatment of PPI and have to be used as targeted therapy. Successful therapy and diagnostics of PPI require following an exact algorithm. The interdisciplinary cooperation between specialists for infectious diseases and microbiologists represents a decisive factor.

Ophthalmic viscosurgical device backflow into cartridge during intraocular lens insertion using injectors

BackgroundThe purpose of this study was to assess the risk of intraocular contamination caused by intraocular lens (IOL) insertion with injectors by observing the dynamics of an ophthalmic viscosurgical device (OVD).MethodsEach type of injector was equipped with a colored OVD and IOL, and a 2 mm length from the tip of the cartridge was replaced with a colored OVD. The various combinations of IOLs and injectors used were: a three-piece shaped IOL, VA60BBR + TypeE1 (HOYA incision size 2.5 mm; group A, n=5); a single-piece IOL, 251+ iSert micro, preloaded (HOYA, incision size 2.2 mm; group G, n=5); and a single-piece IOL, SN6CWS preloaded (Alcon, incision size 2.7 mm; group C, n=5).ResultsIn group A, the intraocular OVD instantly flowed backward into the injector, whereas the colored OVD was pushed backward deep inside the cartridge without flowing into the eye. In group B, the backflow of the intraocular OVD into the injector was limited, resulting in the influx of a large amount of the colored OVD into the eye along with the IOL. In group C, as in group A, a large amount of the intraocular OVD flowed backward into the injector. Consequently, a small amount of the colored OVD flowed into the eye.ConclusionThe tip of the injector and OVD could be contaminated because the surgical field cannot be completely sterile, even after preoperative disinfection. Our experiments revealed that OVD backflow into the injector cavity occurs during IOL insertion, and this phenomenon may have minimized intraocular contamination. However, small-diameter cartridges along with plate-type haptics allow insufficient OVD backflow, resulting in intraocular influx of the contaminated OVD. Surgeons have to be notified that intraoperative bacterial contamination can occur even after IOL insertion using injectors.

Prevention of Late PJI

The definition of late PJI is variable in literature. Majority of the members of the consensus felt that any infection occurring after one year should be considered as late. Coventry defined stages of PJI, where Stage I is an acute infection that occurred within 3 months of the index procedure, Stage II is a delayed infection that occurred between 3 months and 2 years after the index procedure where there was no pain-free interval, and Stage III is a hematogenous infection where there is a pain-free stage [1]. Garvin and Hanssen defined a late chronic PJI as one that occurred 4 weeks after the index procedure with an insidious clinical onset [2]. McPherson et al defined a chronic infection as one that had symptoms for 4 weeks or longer [3]. In Sweden, a late PJI is defined as one that occurs 2 years after the index procedure. Due to the huge variation in time frames, we did not find consensus in defining a timeframe for a late PJI. However, we classified late PJI as late hematogenous PJI, where there was an asymptomatic period followed by clinical and/or radiographical signs of infection. The workgroup feels that late PJI arises as a result of bacteremia at a later stage [4] and should be distinguished with infections arising as a result of intraoperative contamination. Risk factors for late PJI are similar to those described for PJI in Workgroup 1 (Please see Question 1, Workgroup 1).

Response to Nestel

Sir, We thank Dr Nestel1 for his interest in our study.2 We found some associations between the pathogenic conjunctival bacteria and the systemic co-morbidities of patients undergoing cataract surgery, which was the main purpose of the study. Among these associations, we found that enterococci prevalence is associated with age and diabetes. Owing to the current wide use of intracameral cefuroxime for the cataract surgery prophylaxis,3, 4 we introduced the example of the postoperative endophthalmitis (PE) caused by enterococci for illustrating the implications of our findings in the management of patients carrying conjunctival bacteria resistant to a particular prophylaxis, such as the enterococci to cefuroxime, as Dr Nestel pointed. The systemic co-morbidities associations with other bacteria (for instance multi-resistant Staphylococcus) could also help in choosing a prophylaxis. The answers to other comments are as follows: In the study design, polymyxin B plus trimethoprim eye drops is an empirical prophylaxis for all patients, except those having conjunctival pathogen bacteria resistant to these antibiotics, such as enterococci. We try not to increase the resistance to first-line antibiotic treatments. The occurrence of four PE cases in the first year of the study period2 was before using intracameral cefuroxime. This fact could point to streptococci as the most likely cause, as there was no case of Streptococci-PE in the ESCRS groups treated with cefuroxime,5 and no others prophylactic measures had changed in our study. The oral antibiotic for patients with conjunctival enterococci was chosen in accordance with their susceptibility tests;6 quinolones being the first choice, if possible. Finally, the ‘potential' risk of intraocular contamination by enterococci, in patients over 85 years, was calculated with respect to the conjunctival enterococci prevalence of patients younger than 86 years (Supplementary Table 3).2 This information is extended in Table 1. Table 1 Increasing potential risk of intraoperative contamination by enterococci according to age in patients operated on for cataract

The Effect of Laminar Air Flow and Door Openings on Operating Room Contamination

We evaluate the association of laminar airflow (LAF) and OR traffic with intraoperative contamination rates. Two sterile basins were placed in each room during 81 cases, one inside and one outside the LAF. One Replicate Organism Detection and Counting (RODAC) plate from each basin was sent for culture at successive 30-minute intervals from incision time until wound closure. At successive 30-minute intervals more plates were contaminated outside than inside the LAF. A negative binomial model showed that the bacteria colony forming units (CFU) depended on whether there were any door openings (P=0.02) and the presence of LAF (P=0.003). LAF decreases CFU by 36.6%. LAF independently reduces the risk of contamination and microbial counts for surgeries lasting 90 minutes or less.

Prevalence of Intraoperative Tissue Bacterial Contamination in Posterior Pediatric Spinal Deformity Surgery

Retrospective case control study. To determine prevalence and risk factors for intraoperative bacterial contamination in posterior spinal deformity surgery. The prevalence of deep surgical site infection in pediatric spinal deformity surgery varies from 1% to 14%. Little evidence exists about the incidence and role of intraoperative bacterial contamination. A total of 114 cases of pediatric posterior instrumented deformity surgery were retrospectively identified. All patients received preoperative and every 4-hour intraoperative antibiotics and 3M Ioban 2 Antimicrobial Incise Drape. Preoperative photographs of patients' backs were used to correlate presence of back acne with contaminant bacteria. Laboratory cultures were obtained from paraspinal muscle debrided before closure. Of the 114 cultures obtained, 26 (23%) were positive in 21% of idiopathic, 37% of neuromuscular (P = 0.02), and 14% of congenital patients. Contaminant bacteria included Propionibacterium acnes (69%), Staphylococcus (23%), Coryneform (4%), and Clostridium (4%). P. acnes was seen only in children 11 years or older (P = 0.02) and only with back acne (P < 0.0001). Eight of 19 (42%) patients with pelvic fusion had positive cultures (P = 0.04) and all 8 were neuromuscular patients. Eighty-one percent of culture-positive patients were older than 11 years (P = 0.01). Three of 114 (2.7%) patients developed an early deep surgical site infection, all with positive cultures (P = 0.01). Neuromuscular patients fused to the pelvis, children older than 11 years, and surgery duration greater than 6 hours were associated with positive cultures. Back acne is a preventable risk factor for P. acnes seeding. Intraoperative bacterial contamination indicates a need to consider the type of surgery and patient age to determine prophylactic antibiotics and other modalities to prevent infection.

Is low back pain after disc herniation with Modic Type 1 changes a low-grade infection?

In this issue of the European Spine Journal we are confronted with new data concerning the significance of Modic Type 1 changes (MC I) in patients with chronic low back pain. We know from previous studies that MC I occurs six times more frequently in the low back pain population than in the general population. The reason may be of mechanical nature, but under certain circumstances low virulent infections may play a key role. The Danish group of H. B. Albert does not only demonstrate that patients with infected herniated nucleus material by anaerobic bacteria in lumbar disc herniation develop in 80 % new MC I in adjacent vertebrae, but also that those patients with low back pain and MC I after disc herniation improved highly statistically significant on all outcome measures under an antibiotic protocol. This strongly suggests one cause of low back pain in combination of MC I to be of low-grade infectious nature in case of previous disc herniation. Since it is ethically impossible to have biopsies of all those patients who have low back pain and MC I in the context of a disc herniation on the MRI (where starts the definition of disc herniation: annulus disruption and penetration with nucleus material?), but only from those patients who have surgery due to disc herniation, the authors ask the obvious key question, whether or not the bacteria found in the nuclear material is indicative of an infection or is possibly due to intraoperative contamination. The authors give a plausible answer that contamination is highly improbable. Nevertheless, further research is necessary to show what exactly happens in patients with disc herniation who develop MC I and low back pain and who have not been operated on. How could we show that in this fraction of patients there could be the same number of anaerobic infections of the nucleus material? By markers of the anaerobic bacteria or of specific infectious tissue, which could be made visible in imaging? By fine needle biopsy? Such a gain of knowledge would make the results presented here by H. B. Albert et al. even more explosive for the further understanding of low back pain and corresponding MRI changes. We are keen to wait for further innovative research in this field.

Intraoperative contamination and space suits: a potential mechanism

The body exhaust suit (BES) of Charnley creates 'negative pressure' inside the gown using intake/outtake tubing. Modern 'space suit' (SS) systems incorporate helmet-based intake fans, which use the hood material as a filter and create 'positive pressure' inside the gown. While early studies of BES demonstrate a clear reduction in infection rates following arthroplasty, recent clinical data on SS use has paradoxically reported a marked increase. We hypothesized that the positive pressure inside the gown could carry air and particles via the unsealed area around the surgeon's cuff into the operative field. We performed 12 simulated operations with the surgeons hands covered in fluorescent 0.5 micron powder that approximates the size of shedded skin squames. Photographs under UV light and air particle counts were used to compare potential contamination rates between SS and conventional gowns using a standardised scoring system. The highest powder migration was seen in the SS group with a score of 15.3 out of 28. No powder migration was seen in the standard gown group (p=0.028). This study provides a plausible explanation for the increase in infection rates seen with SS use. We recommend SS be considered for personal protection only and supplemented with sealant tape around the inner glove.

The importance of protecting surgical instrument tables from intraoperative contamination in clean surgeries

to compare the degree of bacterial contamination of surgical instrument tables used in clean surgical procedures, either protected with plastic fields, sterilized with ethylene oxide, or disinfected with 70% alcohol and 1% iodine solutions. This is a randomized clinical trial in which samples were collected from the surfaces of surgical instrument tables before and after each procedure. Microbiological analysis was performed to identify microorganisms and their respective antimicrobial resistance. Bacterial growth in the surgeries using sterilized plastic was 5.71% before and 28.6% after surgery and, 2.9% and 45.7% respectively in surgeries using disinfection with 70% alcohol and 1% iodine solutions; no statistical difference was found between the methods. both methods present similar protection, however, 70% alcohol and 1% iodine do not generate solid waste.

Microscope in modern spinal surgery: advantages, ergonomics and limitations

The surgical microscope has revolutionized the practice of modern spine surgery. The major advantages of the microscope include better illumination, magnification and coaxial vision. It has also contributed to the welfare of the surgeon through improved ergonomics and opportunities to demonstrate surgical nuances to a training resident. However, there are limitations to its role in complex, long segment fixations and a potential for higher risk of surgical infections secondary to intraoperative contamination.

Implant contamination during spine surgery

Background contextPostoperative spine infections have been reported to occur in 1% to 15% of patients and subsequently lead to significant morbidity and cost, with an elevated risk for instrumented cases. Every effort should be made to minimize the risk of intraoperative wound contamination. Consequently, certain practices are followed in the operating room to prevent contamination, many of which are not evidence based. Conversely, certain objects believed to be sterile are frequently overlooked as potential sources of contamination. PurposeTo assess to what degree contamination of spinal implants occurs during spine surgery and evaluate whether coverage of implants alters the rate of contamination. Study designProspective study. Study sampleThis study included 105 consecutive noninfection surgical cases performed by a single spine surgeon that required the use of instrumentation. Outcome measureSpinal implant contamination. MethodsCases were randomized to have all implant trays either remain uncovered (n=54) or covered (n=51) with sterile surgical towels on opening until implants were required for the case. After the last implant was placed, a sterile culture swab was used to obtain a sample from all open implants that had been present at the start of the case. The paper outer wraps of the implant trays were sampled in each case as a positive control, and an additional 105 swabs were capped immediately after they were opened to obtain negative controls. Swab samples were assessed for bacterial growth on 5% sheep blood Columbia agar plates. Of note, only departmental funding was used and no applicable financial relationships exist with any author. ResultsNo growth was observed on any of the 105 negative controls, whereas 99.1% of positive controls demonstrated obvious contamination. Cultures from implant samples demonstrated a 9.5% overall rate of contamination with 2.0% (n=1) of covered implants versus 16.7% (n=9) of uncovered implants demonstrating contamination. Length of time implant trays were open before sample collection; implant type (plate, rods, vs. polyetheretherketone), number of scrubbed personnel, and number of implants used were all not found to be significantly associated with implant contamination (p>.05). However, coverage of implants was found to significantly reduce the implant contamination rate (p=.016). ConclusionsThe contamination of sterile implants during spine surgery was found to occur. However, this contamination was independent of the amount of time the implant trays remained open. Coverage of implants significantly reduces this contamination. Therefore, no matter the expected duration of a case, implant coverage is a simple modifiable way to reduce the risk of intraoperative wound contamination and potentially reduce postoperative infections.

Comparison of operating field sterility in open versus minimally invasive microdiscectomies of the lumbar spine

Background:Postoperative wound infection is a preventable risk that can lead to significant adverse outcomes and increased cost of care. Minimally invasive surgeries (MIS) have been found to have lower rates of postoperative infection compared with the traditional approach. To assess if the reported difference is related to intraoperative contamination or to other factors, we assessed the surgical field for sterility.Methods:We compared 10 MIS versus 10 traditional microdiscectomies. Swabs of the operating field were obtained before and after the procedure from multiple sites in the operating room. Positive and negative controls were taken of the skin immediately before and after preparation of the incision site. All swabs were plated out on Columbia blood agar plates and grown for 48 hours. Colony counting was performed to determine growth.Results:There was no statistically significant difference in the colony counts of swab sites in traditional microdiscectomies compared with MIS microdiscectomies. There was no significant contamination of the operating field using either approach.Conclusions:In this prospective study, we found that there was no significant difference in bacterial counts in swabs of operative sites in either traditional or MIS microdiscectomies, suggesting that the decreased rate of postoperative infection in the reported literature for MIS cases may be related to other factors, such as patient selection and/or postoperative care.

Reduction in Intraoperative Bacterial Contamination of Peripheral Intravenous Tubing Through the Use of a Passive Catheter Care System

Bacterial contamination of intravascular devices has been associated with increased morbidity and mortality in various hospital settings, including the perioperative environment. Catheter hub disinfection has been shown in an ex vivo model to attenuate intraoperative injection of bacterial organisms originating from the anesthesia provider's hands, providing the impetus for improvement in intraoperative disinfection techniques and compliance. In the current study, we investigated the clinical effectiveness of a new, passive catheter care station in reducing the incidence of bacterial contamination of open lumen patient IV stopcock sets. The secondary aim was to evaluate the impact of this novel intervention on the combined incidence of 30-day postoperative infections and IV catheter-associated phlebitis. Five hundred ninety-four operating room environments were randomized by a computer-generated list to receive either a novel catheter care bundle (HubScrub and DOCit) or standard caps in conjunction with a sterile, conventional open lumen 3-way stopcock set (24 inch with 3-gang 4-way and T-Connector). Patients underwent general anesthesia according to usual practice and were followed prospectively for 30 postoperative days to identify the development of health care-associated infections (HCAIs) and/or phlebitis. The primary outcome was intraoperative bacterial contamination of the primary stopcock set used by the anesthesia provider(s). The secondary outcome was the combined incidence of 30-day postoperative infections and phlebitis. Five hundred seventy-two operating rooms were included in the final analysis. Study groups were comparable with no significant differences in patient, provider, anesthetic, or procedural characteristics. The catheter care station reduced the incidence of primary stopcock lumen contamination compared with standard caps (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.63-0.98, P = 0.034) and was associated with a reduction in the combined incidence of HCAIs and IV catheter-associated phlebitis with and without adjustment for patient and procedural covariates (OR(adjusted) 0.589, 95% CI 0.353-0.984, P = 0.040). The risk-adjusted number needed to treat to eliminate 1 case of lumen contamination was 9 (95% CI 3.4-13.5) patients, whereas the risk-adjusted number needed to treat to eliminate 1 case of HCAI/catheter-associated phlebitis was 17 (95% CI 11.8-17.9) patients. Intraoperative use of a passive catheter care station significantly reduced open lumen bacterial contamination and the combined incidence of 30-day postoperative infections and phlebitis.