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

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.

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Copyright © 2020 by The Japanese Society for Spine Surgery and Related Research.

Déclaration de conflit d'intérêts

Conflicts of Interest: JW reports royalties from Biomet, SeaSpine, Amedica, and Synthes; investment/options from Bone Biologics, PearlDiver, electroCore, and Surgitech; nonfinancial support from North American Spine Society, Cervical Spine Research Society, Spine, The Spine Journal, Clinical Spine Surgery, Global Spine Journal, Society for Brain Mapping and Therapeutics, American Orthopaedic Association, board of directors from AO Foundation, and Society for Brain Mapping and Therapeutics; and grants from AOSpine North America, outside the submitted work. AA reports royalties from Paradigm Spine and Joimax, consultancy from Spinal Balance, and editorial board membership from Clinical Spine Surgery and Spine, outside the submitted work. SG reports consultancy from DePuy (Johnson & Johnson), Magnifi Group, SI-Bone, Spinal Kinetics, Spinal Balance, institutional support from DePuy (Johnson & Johnson), Globus, royalties from DePuy (Johnson & Johnson), and stock from Spinal Kinetics, Spinal Balance, and SI-Bone outside the submitted work. AKA and VKG report royalties from Paradigm Spine, Joimax and investment/options from OsteoNovus and Spinal Balance, outside the submitted work. CK reports consultancy from Medtronic, SeaSpine, Intellirod, Spinal Balance, and Camber, outside the submitted work. NA reports consultancy from Medtronic, Globus, GYS Tech, and Spinal Balance; speakership from DePuy Synthes and Stryker; stocks from Bonovo, Medtronic, Globus, GYS Tech, Spinal Balance, AF Cell, Theracell, Atlas Spine, and Paradigm Spine; royalties from Elsevier, Medtronic, and Globus; SAB from GYS Tech, Globus, and Spinal Balance; and editorial board membership from Gray's Anatomy, outside the submitted work. The rest of the authors (BL, CS, HE, and VS) have nothing to disclose.