Background and purpose Fomites are increasingly being recognised as a source of hospital-acquired infection. We have therefore assessed tourniquets and exsanguinators for the presence of bacterial pathogens in 1 elective and 2 trauma orthopedic hospitals. Material and methods Swabs were taken prior to and after decontaminating these devices with 1 of 3 different cleaning modalities. These were then assessed for colony counts and organisms identified. Results Bacteria commonly implicated in surgical site infections such as coagulase-negative staphylococci, Staphylococcus aureus and Proteus spp. were prevalent. We also found a resistant strain of Acinetobacter and Candida. Exsanguinators were the most heavily contaminated devices, and colony counts in the trauma hospitals were up to 400% higher than in the elective hospital. Alcohol- and non-alcohol-based sterile wipes were both highly effective in decontaminating the devices. Interpretation Infectious organisms reside on the tourniquets and exsanguinators presently used in the orthopedic theater. These fomites may possibly be a source of surgical site infection. We have demonstrated a simple and effective means of decontaminating these devices between cases.

https://www.tandfonline.com/doi/pdf/10.3109/17453670902930016

Tourniquets and exsanguinators: a potential source of infection in the orthopedic operating theater?

Background: Besides the vast success and reliability of lower extremity joint replacement, deep and periprosthetic infection remains a serious complication of such operations. Many publications addressing periprosthetic infection have remarked about this “devastating” complication, with a risk around 1% after total hip arthroplasty and between 1% and 2% after total knee arthroplasty. The purpose of this study is to assess current trends in prevention of contamination with improved up-to-date pre-operative skin preparation methods and intra-operative draping. Methods: A literature review was conducted in MEDLINE, Web of Science, and the Cochrane database, looking for high-quality papers summarizing the most widely held and up-to-date concepts of perioperative measures for reducing infection, focusing on the best available evidence concerning skin preparation for joint arthroplasty (THR and THR) and surgical draping. Results: Current evidence suggests the use of alcohol solutions for pre-operative ...

Perioperative Skin Preparation and Draping in Modern Total Joint Arthroplasty: Current Evidence.

Aims Determine whether disposable or reusable drapes are better at reducing surgical site infection (SSI) rates. Methods A systematic review of the English literature from inception to 2018 with search terms relating to infection and drapes in orthopaedic and spine surgery. Results No orthopaedic or spinal surgery studies assessed the risk of SSI between reusable or disposable drapes. However, two articles, with conflicting results, compared current reusable and disposable drapes in other surgical disciplines. Conclusion There is no evidence to support a difference between reusable or disposable drapes to reduce the risk of SSI in orthopaedic and spinal surgery.

https://research-information.bris.ac.uk/ws/files/173662684/Manuscript..pdf

Does the type of surgical drape (disposable versus non-disposable) affect the risk of subsequent surgical site infection?

BackgroundClinical infection remains a significant problem in implant-based breast reconstruction and is a physical and emotional strain to the breast reconstruction patient. Bacterial strikethrough of draping and gown material is a likely source of infection. Strategies to reduce infection in impla

The effect of reusable versus disposable draping material on infection rates in implant-based breast reconstruction: a prospective randomized trial.

General Assembly, Prevention, Surgical Site Preparation: Proceedings of International Consensus on Orthopedic Infections.

Purpose. To test the bacterial penetrability of disposable non-woven drapes used specifically for total hip arthroplasty. Methods. 12 round agar plates were inoculated with 107 colony-forming units/ml of coagulase-negative staphylococci (CNS) and incubated in air at 37oC for 18 hours to obtain a semi-confluent growth of organisms. Six brands of disposable drapes were tested; each was assigned to 2 plates. Each disposable drape was placed between a round agar plate and an inverted square agar plate filled with blood agar. After 30 and 90 minutes, the square agar plates were removed and incubated for 48 hours and inspected for growth of CNS. Results. Bacterial penetration was time dependant. Certain brands of drapes were more impenetrable than others; none was impenetrable at all time points, but most remained so or allowed passage of fewer than 100 colony-forming units at 90 minutes. Conclusion. It is recommended that drapes be rigorously tested with regard to their resistance to bacterial penetration.

https://journals.sagepub.com/doi/pdf/10.1177/230949900701500303

A Noel

Papers

Resistance of disposable drapes to bacterial penetration