Updates on Evidence-Based Practices to Reduce Preoperative and Intraoperative Contamination of Implants in Spine Surgery: A Narrative Review

Spine Surgery and Related Research

Chris Karas¹  Anand Agarwal²  Aakash Agarwal²  Boren Lin²  Vijay Goel²  Hossein Elgafy²  Christian Schultz²  Steve Garfin³  Jeffrey Wang⁴  Neel Anand⁵ 

[1] Bone and Joint Center, OhioHealth Grant Medical;Department of Biology, Bioengineering and Orthopaedics Surgery, University of Toledo;Department of Orthopaedics, University of California;Department of Orthopaedics, University of Southern California;Spine Center, Cedars Sinai Medical Center;

关键词: surgical site infection;    contamination;    bioburden;    orthopedic implants;    asepsis;    pedicle screws;    biofilm;    reprocessing;    intraoperative handling;    implant prophylaxis;    occult infection;   

DOI  :  10.22603/ssrr.2019-0038

来源: DOAJ

【 摘 要 】

The current communication seeks to provide an updated narrative review on latest methods of reducing implant contaminations used during spine surgery. Recent literature review has shown that both preoperative reprocessing and intraoperative handling of implants seem to contaminate implants. In brief, during preoperative phase, the implants undergo repeated bulk cleaning with dirty instruments from the OR, leading to residue buildup at the interfaces and possibly on the surfaces too. This, due to its concealed nature, remains unnoticed by the SPD (sterile processing department) or other hospital staff. Nevertheless, these can be avoided by using individually prepackaged presterilized implants. In the intraoperative phase, the implants (in the sterile field) are directly touched by the scrub tech with soiled (assisting the surgeon dispose the tissues from the instruments in use) gloves for loading onto an insertion device. It is then kept exposed on the working table (either separately or next to the used instruments as the pedicles hole are being prepared). Latest investigation has shown that by the time it is implanted in the patient, it can harbor up to 10e7 bacterial colony-forming units. The same implants were devoid of such colony-forming units, when sheathed by an impermeable sterile sheath around the sterile implant.

【 授权许可】

Unknown