Implant contamination as a cause of surgical site infection in spinal surgery: are single-use implants a reasonable solution? - a systematic review.
Bacteria
Implant contamination
Single-use implants
Spinal surgery
Sterilization
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
25 Sep 2020
25 Sep 2020
Historique:
received:
22
04
2020
accepted:
16
09
2020
entrez:
26
9
2020
pubmed:
27
9
2020
medline:
15
5
2021
Statut:
epublish
Résumé
In spine surgery, surgical site infection (SSI) is one of the main perioperative complications and is associated with a higher patient morbidity and longer patient hospitalization. Most factors associated with SSI are connected with asepsis during the surgical procedure and thus with contamination of implants and instruments used which can be caused by pre- and intraoperative factors. In this systematic review we evaluate the current literature on these causes and discuss possible solutions to avoid implant and instrument contamination. A systematic literature search of PubMed addressing implant, instrument and tray contamination in orthopaedic and spinal surgery from 2001 to 2019 was conducted following the PRISMA guidelines. All studies regarding implant and instrument contamination in orthopaedic surgery published in English language were included. Thirty-five studies were eligible for inclusion and were divided into pre- and intraoperative causes for implant and instrument contamination. Multiple studies showed that reprocessing of medical devices for surgery may be insufficient and lead to surgical site contamination. Regarding intraoperative causes, contamination of gloves and gowns as well as contamination via air are the most striking factors contributing to microbial contamination. Our systematic literature review shows that multiple factors can lead to instrument or implant contamination. Intraoperative causes of contamination can be avoided by implementing behavior such as changing gloves right before handling an implant and reducing the instruments' intraoperative exposure to air. In avoidance of preoperative contamination, there still is a lack of convincing evidence for the use of single-use implants in orthopaedic surgery.
Sections du résumé
BACKGROUND
BACKGROUND
In spine surgery, surgical site infection (SSI) is one of the main perioperative complications and is associated with a higher patient morbidity and longer patient hospitalization. Most factors associated with SSI are connected with asepsis during the surgical procedure and thus with contamination of implants and instruments used which can be caused by pre- and intraoperative factors. In this systematic review we evaluate the current literature on these causes and discuss possible solutions to avoid implant and instrument contamination.
METHODS
METHODS
A systematic literature search of PubMed addressing implant, instrument and tray contamination in orthopaedic and spinal surgery from 2001 to 2019 was conducted following the PRISMA guidelines. All studies regarding implant and instrument contamination in orthopaedic surgery published in English language were included.
RESULTS
RESULTS
Thirty-five studies were eligible for inclusion and were divided into pre- and intraoperative causes for implant and instrument contamination. Multiple studies showed that reprocessing of medical devices for surgery may be insufficient and lead to surgical site contamination. Regarding intraoperative causes, contamination of gloves and gowns as well as contamination via air are the most striking factors contributing to microbial contamination.
CONCLUSIONS
CONCLUSIONS
Our systematic literature review shows that multiple factors can lead to instrument or implant contamination. Intraoperative causes of contamination can be avoided by implementing behavior such as changing gloves right before handling an implant and reducing the instruments' intraoperative exposure to air. In avoidance of preoperative contamination, there still is a lack of convincing evidence for the use of single-use implants in orthopaedic surgery.
Identifiants
pubmed: 32977778
doi: 10.1186/s12891-020-03653-z
pii: 10.1186/s12891-020-03653-z
pmc: PMC7519515
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
634Références
Surg Neurol Int. 2013 Oct 29;4(Suppl 5):S392-403
pubmed: 24340238
J Hosp Infect. 2019 Jan;101(1):13-19
pubmed: 30339821
J Orthop Traumatol. 2011 Dec;12(4):207-11
pubmed: 22072304
Spine (Phila Pa 1976). 2015 Aug 15;40(16):1247-51
pubmed: 25929209
Ann R Coll Surg Engl. 2000 Nov;82(6):405-7
pubmed: 11103158
Spine (Phila Pa 1976). 2010 Jun 1;35(13):1323-8
pubmed: 20150831
Am J Infect Control. 2018 Sep;46(9):1009-1013
pubmed: 29661627
J Hosp Infect. 2004 Apr;56(4):318-20
pubmed: 15066744
Injury. 2009 Feb;40(2):163-5
pubmed: 19095232
Global Spine J. 2019 Feb;9(1):62-66
pubmed: 30775210
Clin Orthop Relat Res. 2017 Jul;475(7):1819-1824
pubmed: 28050814
BMC Surg. 2017 Jul 6;17(1):78
pubmed: 28683726
Global Spine J. 2019 Apr;9(2):173-178
pubmed: 30984497
Ann Surg. 2014 Mar;259(3):591-7
pubmed: 24045444
Am J Infect Control. 2014 Jun;42(6):665-9
pubmed: 24713595
BMJ Open Qual. 2019 May 29;8(2):e000493
pubmed: 31206056
Knee Surg Sports Traumatol Arthrosc. 2020 Jun;28(6):1774-1779
pubmed: 31256214
Spine (Phila Pa 1976). 2013 Jul 1;38(15):1318-23
pubmed: 23459132
Global Spine J. 2018 Oct;8(7):761-765
pubmed: 30443488
PLoS Med. 2009 Jul 21;6(7):e1000100
pubmed: 19621070
Am J Infect Control. 2018 Jul;46(7):837-839
pubmed: 29395510
Ann R Coll Surg Engl. 2011 Mar;93(2):130-2
pubmed: 21092415
J Arthroplasty. 2016 Aug;31(8):1746-9
pubmed: 26948131
Arch Orthop Trauma Surg. 2019 Apr;139(4):451-459
pubmed: 30406429
BMJ Open. 2015 Dec 15;5(12):e009011
pubmed: 26671956
Clin Orthop Relat Res. 2007 Sep;462:207-11
pubmed: 17452915
J Bone Joint Surg Br. 2012 Mar;94(3):359-64
pubmed: 22371544
J Clin Neurosci. 2015 Dec;22(12):1862-6
pubmed: 26282155
Am J Infect Control. 2018 Aug;46(8):954-956
pubmed: 29735254
J Hosp Infect. 2019 Sep;103(1):e53-e60
pubmed: 30423413
Ann R Coll Surg Engl. 2007 Sep;89(6):605-8
pubmed: 18201476
J Bone Joint Surg Am. 2008 May;90(5):1022-5
pubmed: 18451394
Int J Spine Surg. 2016 Apr 21;10:14
pubmed: 27441172
Am J Infect Control. 2012 Oct;40(8):750-5
pubmed: 22285652
Patient Saf Surg. 2014 Jun 26;8:27
pubmed: 25006349
Arch Orthop Trauma Surg. 2019 Jul;139(7):1015-1019
pubmed: 31127407
Neurosurgery. 2017 Mar 01;80(3S):S114-S123
pubmed: 28350942
Ann R Coll Surg Engl. 2009 Mar;91(2):131-4
pubmed: 19317936
Eur J Orthop Surg Traumatol. 2016 Jan;26(1):21-6
pubmed: 26325248
Spine J. 2013 Jun;13(6):637-40
pubmed: 23321148
Eur Spine J. 2010 Oct;19(10):1711-9
pubmed: 20445999
J Hosp Infect. 2006 Feb;62(2):174-80
pubmed: 16343691
Am J Infect Control. 2010 Apr;38(3):229-33
pubmed: 19913328
Injury. 2018 Nov;49(11):2005-2012
pubmed: 30236794
J Knee Surg. 2013 Aug;26(4):285-90
pubmed: 23359398
J Hosp Infect. 2002 Apr;50(4):281-5
pubmed: 12014901