Medical Microbiology Department, Southern General Hospital, Glasgow, UK.
Infection and Immunity Group, Glasgow Dental School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
J Hosp Infect. 2015 Jul;90(3):179-85. doi: 10.1016/j.jhin.2015.03.006. Epub 2015 Apr 9.
Surgical power tools (SPTs) are frequently used in many surgical specialties such as dentistry, orthopaedics, ophthalmology, neurology, and podiatry. They have complex designs that may restrict access to cleaning and sterilization agents and frequently become contaminated with microbial and tissue residues following use. Due to these challenges, surgical power tools can be considered the weak link in the decontamination cycle and present a potential for iatrogenic transmission of infection. We aimed to review the existing literature on the decontamination of surgical power tools and associated iatrogenic transmission of infection. A search of the medical literature was performed using Ovid online using the following databases: Ovid Medline 1950-2014, Embase 1980-2014, and EBM Reviews Full Text--Cochrane DSR, ACP Journal Club, and Dare. Despite challenges to decontamination processes, reported episodes of iatrogenic infection directly linked to SPTs appear rare. This may reflect a true picture but more likely represents incomplete reporting, failure to investigate power tools, or lack of surveillance linking surgical site infections (SSIs) to power tools. Healthcare professionals should be aware of the complexities associated with the decontamination of different SPTs, and should review manufacturers' reprocessing instructions prior to purchase. More clarity is required in the manufacturers' validation of these reprocessing instructions. This particularly applies to the emerging surgical robot systems that present extreme challenges to decontamination between uses. Investigation of cross-infection incidents or SSI surveillance should include an element of assessment of SPT decontamination to further elucidate the contribution of SPTs to skin and soft tissue infections.
外科动力工具（Surgical power tools，SPTs）常用于许多外科专业领域，如牙科、矫形外科、眼科、神经科和足病学。它们具有复杂的设计，可能限制了清洁和消毒剂的进入，并且在使用后经常会受到微生物和组织残留的污染。由于这些挑战，外科动力工具可以被认为是消毒循环中的薄弱环节，并存在潜在的医源性感染传播风险。我们旨在回顾现有的关于外科动力工具消毒及其相关医源性感染传播的文献。使用 Ovid 在线在以下数据库中进行了医学文献检索：Ovid Medline 1950-2014、Embase 1980-2014 以及 EBM Reviews Full Text--Cochrane DSR、ACP 期刊俱乐部和 Dare。尽管消毒过程存在挑战，但直接与 SPT 相关的医源性感染报告病例似乎很少。这可能反映了真实情况，但更可能代表了不完全报告、未能调查动力工具或缺乏将手术部位感染（SSIs）与动力工具联系起来的监测。医疗保健专业人员应该意识到与不同 SPT 消毒相关的复杂性，并在购买前审查制造商的再处理说明。制造商对这些再处理说明的验证需要更明确。这尤其适用于新兴的外科机器人系统，这些系统在使用之间的消毒方面带来了极端挑战。交叉感染事件的调查或 SSI 监测应包括评估 SPT 消毒的内容，以进一步阐明 SPT 对皮肤和软组织感染的贡献。
