No significant difference in skin contamination during anterior cruciate ligament reconstruction with and without preoperative skin cleaning.

ACL reconstruction antiseptic wash lotion contamination prophylaxis surgical site infection

Journal

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730

Informations de publication

Date de publication:
03 Oct 2024
Historique:
revised: 05 09 2024
received: 13 05 2024
accepted: 06 09 2024
medline: 3 10 2024
pubmed: 3 10 2024
entrez: 3 10 2024
Statut: aheadofprint

Résumé

This prospective study aimed to assess whether preoperative antiseptic skin cleansing reduces bacterial contamination and surgical site infections (SSI) following anterior cruciate ligament reconstruction (ACLR). We hypothesized that antiseptic cleaning would lower bacterial load, reducing contamination and early infections. One hundred and nineteen patients scheduled for ACLR were included in this prospective, nonrandomized study. Individuals were divided into two groups. Patients in the intervention group applied octenisan® wash lotion daily for three days before surgery and used the wash solution instead of their usual shower gel. Additionally, they swiped their leg with octenisan® soaked gloves on the morning of the operation. The control group followed their usual wash routine with no specific instructions. Fluid samples were taken before surgery from the irrigation bag and at 15-min intervals from the reservoir of the sterile surgical drape during the procedure. Suture material used for the ACL graft and meniscus repair were also collected for testing. The samples were subjected to a 14-day incubation period. Follow-up included outpatient visits at 6 weeks, 12 weeks and 6 months with a final evaluation at 12 months. Contamination rates showed no significant difference between the control and intervention groups. The mean contamination rate in the control group was 6.4% (n = 22) and 6.6% (n = 24) in the intervention group (p = 0.28). At 12-month follow-up, 110 out of 119 participants were included (52 control, 58 intervention). T tests for age (p = 0.19), BMI (p = 0.66), and surgery duration (p = 0.38) showed no significant differences. No early SSI were observed in either group postoperatively. Our results indicate that the use of antiseptic wash lotion and gloves does not influence the risk of bacterial contamination during surgery. Level III.

Identifiants

pubmed: 39359237
doi: 10.1002/ksa.12476
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Richard and Annemarie Wolf Foundation

Informations de copyright

© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.

Références

Abram, S.G.F., Judge, A., Beard, D.J. & Price, A.J. (2019) Rates of adverse outcomes and revision surgery after anterior cruciate ligament reconstruction: a study of 104,255 procedures using the national hospital episode statistics database for England, UK. The American Journal of Sports Medicine, 47, 2533–2542. Available from: https://doi.org/10.1177/0363546519861393
Al‐Maiyah, M., Bajwa, A., Finn, P., Mackenney, P., Hill, D., Port, A. et al. (2005) Glove perforation and contamination in primary total hip arthroplasty. The Journal of Bone and Joint Surgery. British Volume, 87, 556–559. Available from: https://doi.org/10.1302/0301-620X.87B4.15744
Bartek, B., Winkler, T., Garbe, A., Schelberger, T., Perka, C. & Jung, T. (2022) Bacterial contamination of irrigation fluid and suture material during ACL reconstruction and meniscus surgery: low infection rate despite increasing contamination over surgery time. Knee Surgery, Sports Traumatology, Arthroscopy, 30, 246–252. Available from: https://doi.org/10.1007/s00167-021-06481-3
Bauer, T., Boisrenoult, P. & Jenny, J.Y. (2015) Post‐arthroscopy septic arthritis: current data and practical recommendations. Orthopaedics & Traumatology: Surgery & Research, 101, S347–S350. Available from: https://doi.org/10.1016/j.otsr.2015.09.004
Bohu, Y., Klouche, S., Herman, S., de Pamphilis, O., Gerometta, A. & Lefevre, N. (2019) Professional athletes are not at a higher risk of infections after anterior cruciate ligament reconstruction: incidence of septic arthritis, additional costs, and clinical outcomes from the French Prospective Anterior Cruciate Ligament Study (FAST) cohort. The American Journal of Sports Medicine, 47, 104–111. Available from: https://doi.org/10.1177/0363546518810527
Byrd, A.L., Belkaid, Y. & Segre, J.A. (2018) The human skin microbiome. Nature Reviews Microbiology, 16, 143–155. Available from: https://doi.org/10.1038/nrmicro.2017.157
Carney, J., Heckmann, N., Mayer, E.N., Alluri, R.K., Vangsness Jr., C.T., Hatch III, G.F.H. et al. (2018) Should antibiotics be administered before arthroscopic knee surgery? A systematic review of the literature. World Journal of Orthopedics, 9, 262–270. Available from: https://doi.org/10.5312/wjo.v9.i11.262
Clement, R.C., Haddix, K.P., Creighton, R.A., Spang, J.T., Tennant, J.N. & Kamath, G.V. (2016) Risk factors for infection after knee arthroscopy: analysis of 595,083 cases from 3 United States databases. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 32, 2556–2561. Available from: https://doi.org/10.1016/j.arthro.2016.04.026
Darouiche, R.O., Wall Jr., M.J., Itani, K.M.F., Otterson, M.F., Webb, A.L., Carrick, M.M. et al. (2010) Chlorhexidine‐alcohol versus povidone‐iodine for surgical‐site antisepsis. New England Journal of Medicine, 362, 18–26. Available from: https://doi.org/10.1056/NEJMoa0810988
El‐Kady, R.A.E.H. & ElGuindy, A.M.F. (2022) Septic arthritis complicating arthroscopic anterior cruciate ligament reconstruction: an experience from a tertiary‐care hospital. Infection and Drug Resistance, 15, 3779–3789. Available from: https://doi.org/10.2147/IDR.S369240
Figueroa, F., Figueroa, D., Calvo, R., Vaisman, A., Nuñez, M. & Putnis, S. (2022) Vancomycin presoaking of the graft appears to prevent infection after anterior cruciate ligament reconstruction: a systematic review and meta‐analysis. HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery, 18, 138–144. Available from: https://doi.org/10.1177/15563316211011682
Fuchs, M., von Roth, P., Pfitzner, T., Kopf, S., Sass, F.A. & Hommel, H. (2018) Contamination of irrigation fluid during primary total knee arthroplasty. JAAOS: Global Research and Reviews, 2, e027. Available from: https://doi.org/10.5435/JAAOSGlobal-D-17-00027
Hayek, L.J. & Emerson, J.M. (1988) Preoperative whole body disinfection—a controlled clinical study. Journal of Hospital Infection, 11(Suppl B), 15–19. Available from: https://doi.org/10.1016/0195-6701(88)90151-X
Hong, C.K., Hsu, K.L., Kuan, F.C., Lee, Y.T., Tsai, P.F., Chen, P.L. et al. (2023) Extended skin cleaning on the shoulder with chlorhexidine reduces the cutaneous bacterial load but fails to decrease suture contamination in patients undergoing arthroscopy rotator cuff repair. Journal of Shoulder and Elbow Surgery, 32, 744–750. Available from: https://doi.org/10.1016/j.jse.2022.10.033
Kajita, Y., Iwahori, Y., Harada, Y., Deie, M. & Takahashi, R. (2020) Detection of Cutibacterium acnes in arthroscopic rotator cuff and bankart repair. Journal of Orthopaedic Science, 25, 825–829. Available from: https://doi.org/10.1016/j.jos.2019.10.015
Köck, R., Denkel, L., Fessler, A.T., Eicker, R., Mellmann, A., Schwarz, S. et al. (2023) Clinical evidence for the use of octenidine dihydrochloride to prevent healthcare‐associated infections and decrease Staphylococcus aureus carriage or transmission—a review. Pathogens, 12, 612. Available from: https://doi.org/10.3390/pathogens12040612
Kraus Schmitz, J., Lindgren, V., Edman, G., Janarv, P.M., Forssblad, M. & Stålman, A. (2021) Risk factors for septic arthritis after anterior cruciate ligament reconstruction: a nationwide analysis of 26,014 ACL reconstructions. The American Journal of Sports Medicine, 49, 1769–1776. Available from: https://doi.org/10.1177/0363546521993812
Krutsch, W., Zellner, J., Zeman, F., Nerlich, M., Koch, M., Pfeifer, C. et al. (2017) Sports‐specific differences in postsurgical infections after arthroscopically assisted anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 25, 3878–3883. Available from: https://doi.org/10.1007/s00167-016-4385-6
McAllister, D.R., Parker, R.D., Cooper, A.E., Recht, M.P. & Abate, J. (1999) Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. The American Journal of Sports Medicine, 27, 562–570. Available from: https://doi.org/10.1177/03635465990270050301
Weinstein, R.A., Milstone, A.M., Passaretti, C.L. & Perl, T.M. (2008) Chlorhexidine: expanding the armamentarium for infection control and prevention. Clinical Infectious Diseases, 46, 274–281. Available from: https://doi.org/10.1086/524736
Moriarty, P., Kayani, B., Wallace, C., Chang, J., Plastow, R. & Haddad, F.S. (2021) Gentamicin pre‐soaking of hamstring autografts decreases infection rates in anterior cruciate ligament reconstruction. Bone & Joint Open, 2, 66–71. Available from: https://doi.org/10.1302/2633-1462.21.BJO-2020-0181.R1
Morris, B.J., Kiser, C.J., Laughlin, M.S., Sheth, M.M., Dunn, W.R., Elkousy, H.A. et al. (2021) A localized laminar flow device decreases airborne particulates during shoulder arthroplasty: a randomized controlled trial. Journal of Shoulder and Elbow Surgery, 30, 580–586. Available from: https://doi.org/10.1016/j.jse.2020.08.035
Offerhaus, C., Balke, M., Hente, J., Gehling, M., Blendl, S. & Höher, J. (2019) Vancomycin pre‐soaking of the graft reduces postoperative infection rate without increasing risk of graft failure and arthrofibrosis in ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 27, 3014–3021. Available from: https://doi.org/10.1007/s00167-018-5323-6
Offerhaus, C., Jaecker, V., Shafizadeh, S., Müller, L., Hahne, H., Wisplinghoff, H. et al. (2023) Semitendinosus tendons are commonly contaminated with skin flora during graft harvest for anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 31, 4824–4832. Available from: https://doi.org/10.1007/s00167-023-07522-9
Pérez‐Prieto, D., Portillo, M.E., Torres‐Claramunt, R., Pelfort, X., Hinarejos, P. & Monllau, J.C. (2018) Contamination occurs during ACL graft harvesting and manipulation, but it can be easily eradicated. Knee Surgery, Sports Traumatology, Arthroscopy, 26, 558–562. Available from: https://doi.org/10.1007/s00167-017-4735-z
Pérez‐Prieto, D., Totlis, T., Madjarevic, T., Becker, R., Ravn, C., Monllau, J.C. et al. (2023) ESSKA and EBJIS recommendations for the management of infections after anterior cruciate ligament reconstruction (ACL‐R): prevention, surgical treatment and rehabilitation. Knee Surgery, Sports Traumatology, Arthroscopy, 31, 4204–4212. Available from: https://doi.org/10.1007/s00167-023-07463-3
Rotter, M.L., Larsen, S.O., Cooke, E.M., Dankert, J., Daschner, F., Greco, D. et al. (1988) A comparison of the effects of preoperative whole‐body bathing with detergent alone and with detergent containing chlorhexidine gluconate on the frequency of wound infections after clean surgery. Journal of Hospital Infection, 11, 310–320. Available from: https://doi.org/10.1016/0195-6701(88)90083-7
Rousseau, R., Labruyere, C., Kajetanek, C., Deschamps, O., Makridis, K.G. & Djian, P. (2019) Complications after anterior cruciate ligament reconstruction and their relation to the type of graft: a prospective study of 958 cases. The American Journal of Sports Medicine, 47, 2543–2549. Available from: https://doi.org/10.1177/0363546519867913
Sonnery‐Cottet, B., Saithna, A., Abreu, F.G., Franck, F., de Abreu, G.V., Vieira, T.D. et al. (2019) Professional athletes are at higher risk of septic arthritis after anterior cruciate ligament reconstruction: an analysis of 4421 consecutive patients including 265 elite athletes from the SANTI study group. The American Journal of Sports Medicine, 47, 2910–2918. Available from: https://doi.org/10.1177/0363546519869326
Zhao, D., Liang, G.H., Pan, J.K., Zeng, L.F., Luo, M.H., Huang, H.T. et al. (2023) Risk factors for postoperative surgical site infections after anterior cruciate ligament reconstruction: a systematic review and meta‐analysis. British Journal of Sports Medicine, 57, 118–128. Available from: https://doi.org/10.1136/bjsports-2022-105448

Auteurs

Benjamin Bartek (B)

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.

Alexandra Völkner (A)

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.

Stephan Oehme (S)

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.

Stephen Fahy (S)

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.

Tobias Winkler (T)

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.
Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.
Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.

Tobias Jung (T)

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.

Classifications MeSH