Mufarrih Syed H, Qureshi Nada Q, Rashid Rizwan H, Ahmed Bilal, Irfan Seema, Zubairi Akbar J, Noordin Shahryar
Orthopedic Surgery, Aga Khan University, Karachi, PAK.
Cardiology, Aga Khan University, Karachi, PAK.
Cureus. 2019 Aug 2;11(8):e5308. doi: 10.7759/cureus.5308.
Background The rate of surgical site infections following orthopedic procedures is approximately 2% globally. Potential sources of contamination in the operating room include pneumatic tourniquets, blood pressure cuffs, and stethoscopes, among others. Our study aims to investigate microbial colonization on reusable pneumatic tourniquets stored and used in the orthopedic department of our institution and evaluate the efficacy of the cleaning protocols employed. Methods Over a course of two weeks, 26 samples were obtained. A total of 14 pneumatic tourniquets were sampled preoperatively on Monday morning following the weekly cleaning protocol of soaking the tourniquets in sodium hypochlorite for 30 minutes while 12 tourniquets were cultured immediately following the postoperative cleaning protocol of wiping the tourniquet clean with a cloth soaked in sodium hypochlorite. Samples were cultured on MacConkey and sheep blood agar and incubated at 37-degrees centigrade for a total of 48 hours. Organisms were identified and colony count was documented. The analysis was performed using the Fisher Exact test on SPSS v23 (IBM Corp., Armonk, NY, US). Results All 14 samples obtained after being soaked in sodium hypochlorite for 30 minutes cultured negative. However, four out of 12 (33%) samples obtained after simply wiping the pneumatic tourniquet with a cloth soaked in sodium hypochlorite cultured coagulase-negative Staphylococci. The difference between the two was significant (p=0.002). Conclusion Postoperative tourniquets, wiped with a cloth soaked in sodium hypochlorite and ready to be used on the next patient, were found to be contaminated with coagulase-negative Staphylococcus. This species is notorious for causing surgical site infections following implant-related surgeries potentially through direct inoculation and cross-infections intraoperatively and in storage. Efforts to identify the relationship with postoperative surgical site infections need to be made to suggest more aggressive cleaning protocols.
全球范围内，骨科手术后手术部位感染率约为2%。手术室潜在的污染源包括气动止血带、血压袖带和听诊器等。我们的研究旨在调查我院骨科储存和使用的可重复使用气动止血带上的微生物定植情况，并评估所采用清洁方案的效果。方法：在两周的时间里，共采集了26个样本。按照每周的清洁方案，在周一上午术前对14个气动止血带进行采样，将止血带浸泡在次氯酸钠中30分钟；而在术后按照清洁方案，用浸有次氯酸钠的布擦拭止血带后，立即对12个止血带进行培养。样本在麦康凯琼脂和羊血琼脂上培养，并在37摄氏度下孵育48小时。鉴定微生物并记录菌落计数。使用SPSS v23（美国纽约州阿蒙克市IBM公司）的Fisher精确检验进行分析。结果：浸泡在次氯酸钠中30分钟后采集的所有14个样本培养结果均为阴性。然而，在用浸有次氯酸钠的布简单擦拭气动止血带后采集的12个样本中，有4个（33%）培养出凝固酶阴性葡萄球菌。两者之间的差异具有统计学意义（p=0.002）。结论：发现术后用浸有次氯酸钠的布擦拭并准备用于下一位患者的止血带被凝固酶阴性葡萄球菌污染。该菌种因在植入相关手术后可能通过术中及储存时的直接接种和交叉感染导致手术部位感染而声名狼藉。需要努力确定其与术后手术部位感染的关系，以提出更积极的清洁方案。
