Biswas Debdut, Bible Jesse E, Whang Peter G, Simpson Andrew K, Grauer Jonathan N
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06520-8071, USA.
Spine (Phila Pa 1976). 2008 Aug 1;33(17):1913-7. doi: 10.1097/BRS.0b013e31817bb130.
Prospective study evaluating the sterility of 25 C-arm drapes after their use during spine surgery.
To use swab samples to evaluate the sterility of draped C-arms at the end of spine surgical cases and assess the integrity of the sterile technique.
Intraoperative fluoroscopy is used routinely in the operating room for a variety of spinal applications. Although the C-arm may help the surgeon assess spinal alignment and facilitate the placement of instrumentation, there are concerns that the C-arm may represent a potential source of contamination and increase the risk of developing a postoperative infection. METHODS.: This study included 25 surgical cases requiring a standard fluoroscopic C-arm that were performed by 2 spine surgeons. Sterile culture swabs were used to obtain samples from 5 defined locations on the C-arm drape after its use during the operation. The undraped technician's console was sampled in each case as a positive control and an additional 25 C-arm drapes were swabbed immediately after they were applied to the C-arm unit in order to obtain negative controls. Swab samples were assessed for bacterial growth on 5% sheep blood Columbia agar plates using a semiquantitative technique.
Contamination was noted on only 1 of 25 negative control drapes at a single location (4%). One hundred percent and 96% of the positive control swabs that were obtained from the negative controls and postoperative drapes exhibited growth, respectively. Although at least some degree of contamination was observed at all locations of the C-arm drape after surgery, the upper 2 sample sites demonstrated the greatest degree of contamination; the incidences of postoperative contamination were significantly greater for the top (56%, P < 0.000001) and upper front of the receiver (28%, P = 0.010) compared to the negative controls. In contrast, the lower front, receiver plate, and midportion of the C-arm were associated with lower rates of contamination (12%-20%).
The upper portions of the C-arm clearly exhibited the greatest rates of contamination during spinal operations. This contamination most likely occurs when the undraped portions of the C-arm are rotated to acquire lateral images. As a result, we no longer consider the top portion of the C-arm drape to be sterile in these situations and we believe that avoiding contact with these areas may decrease the risks of intraoperative contamination and possibly postoperative infection as well.
一项前瞻性研究，评估25块C型臂手术巾在脊柱手术使用后的无菌状态。
使用拭子样本评估脊柱手术结束时覆盖C型臂的无菌状态，并评估无菌技术的完整性。
术中荧光透视在手术室中常规用于多种脊柱手术。尽管C型臂可帮助外科医生评估脊柱对线并便于器械放置，但人们担心C型臂可能是潜在的污染源，并增加术后感染的风险。
本研究纳入了由2名脊柱外科医生进行的25例需要标准荧光透视C型臂的手术病例。在手术中使用后，用无菌培养拭子从C型臂手术巾上5个确定的位置获取样本。在每个病例中，对未覆盖的技术人员控制台进行采样作为阳性对照，并在另外25块C型臂手术巾应用于C型臂设备后立即进行擦拭以获得阴性对照。使用半定量技术在5%羊血哥伦比亚琼脂平板上评估拭子样本的细菌生长情况。
在25块阴性对照手术巾中，仅1块在单个位置出现污染（4%）。从阴性对照和术后手术巾获取的阳性对照拭子分别有100%和96%出现生长。尽管术后在C型臂手术巾的所有位置均观察到至少某种程度的污染，但上部2个采样部位的污染程度最高；与阴性对照相比，接收器顶部（56%，P<0.000001）和上部前方（28%，P = 0.010）的术后污染发生率显著更高。相比之下，C型臂的下部前方、接收器板和中部的污染率较低（12%-20%）。
在脊柱手术过程中，C型臂的上部明显表现出最高的污染率。这种污染很可能发生在C型臂未覆盖部分旋转以获取侧位图像时。因此，在这些情况下，我们不再认为C型臂手术巾的顶部是无菌的，并且我们认为避免接触这些区域可能会降低术中污染以及可能的术后感染风险。
