Singh Vinay Kumar, Hussain Shazeena, Javed Sadaf, Singh Ivor, Mulla Rohinton, Kalairajah Yegappan
Department of Trauma and Orthopaedics, Epsom and St. Helier Hospital, Carshalton, United Kingdom.
J Orthop Surg (Hong Kong). 2011 Aug;19(2):234-7. doi: 10.1177/230949901101900222.
To evaluate the sterility of the sterile surgical helmet system (SSHS) during elective total hip and knee arthroplasty in theatres with (n=20) and without (n=20) laminar flow.
Three surgeons performed 14 total knee arthroplasties (TKAs) and 6 total hip arthroplasties (THAs) in a laminar flow theatre and 15 TKAs and 5 THAs in a non-laminar flow theatre. An SSHS was used in all the procedures. Samples were taken from the hood at 30-minute intervals during surgery. Swabs were then broken into cooked meat broths for cultivation of organisms. The broths were then directly inoculated onto blood agar and fastidious anaerobic agar for culture of aerobic and anaerobic bacteria, respectively. After 24 hours, these plates were reinoculated with broths that had been incubated for 24 hours. Microbial growth was quantified as 0 (none), 1 (mild), 2 (moderate) and 3 (heavy). Bacterial contamination in the 2 groups at 30, 60 and 90 minutes was compared.
Respectively in the laminar and non-laminar flow theatres, 0 and 9 of the SSHSs showed bacterial growth after direct inoculation, and 14 and 18 of the SSHSs grew 18 and 24 types of organisms in the swab cultures after 24 hours of incubation. Respectively at 30, 60, and 90 minutes, the degree of contamination from direct incubation was significant, but the degree of contamination on swabs after 24 hours of inoculation was not significant. The mean time-dependent contamination after direct inoculation was 0 for the laminar flow group and 0.5, 0.75, and 1.0 for the non-laminar flow group, whereas the corresponding values after 24 hours of incubation were 1.8, 1.8, and 2.6, and 2, 2.75, and 2.95. Coagulase negative Staphylococcus aureus was the most common organism in both groups.
80% of SSHSs used were contaminated intra-operatively. Direct contact with the SSHS should be avoided by the operating team during surgery. Routine changing of gloves in case of contact with the SSHS should be practised.
评估无菌手术头盔系统（SSHS）在有层流（n = 20）和无层流（n = 20）的手术室中进行择期全髋关节和膝关节置换术期间的无菌性。
三名外科医生在层流手术室中进行了14例全膝关节置换术（TKA）和6例全髋关节置换术（THA），在非层流手术室中进行了15例TKA和5例THA。所有手术均使用SSHS。手术期间每隔30分钟从面罩采集样本。然后将拭子放入熟肉培养基中培养微生物。然后将培养基分别直接接种到血琼脂和苛求厌氧琼脂上，以培养需氧菌和厌氧菌。24小时后，将这些平板用已培养24小时的培养基重新接种。微生物生长量化为0（无）、1（轻度）、2（中度）和3（重度）。比较两组在30、60和90分钟时的细菌污染情况。
在层流和非层流手术室中，直接接种后分别有0个和9个SSHS显示细菌生长，培养24小时后，分别有14个和18个SSHS在拭子培养物中生长出18种和24种微生物。分别在30、60和90分钟时，直接培养的污染程度有显著差异，但接种24小时后拭子上的污染程度无显著差异。层流组直接接种后的平均时间依赖性污染为0，非层流组为0.5、0.75和1.0，而培养24小时后的相应值分别为1.8、1.8和2.6，以及2、2.75和2.95。凝固酶阴性金黄色葡萄球菌是两组中最常见的微生物。
所使用的SSHS中有80%在手术中被污染。手术团队在手术期间应避免直接接触SSHS。如果接触了SSHS，应常规更换手套。
