Agarwal Aakash, Lin Boren, Elgafy Hossein, Goel Vijay, Karas Chris, Schultz Christian, Anand Neel, Garfin Steve, Wang Jeffrey, Agarwal Anand
Department of Biology, Bioengineering and Orthopaedics Surgery, University of Toledo, Toledo, USA.
Bone and Joint Center, OhioHealth Grant Medical, Columbus, USA.
Spine Surg Relat Res. 2019 Jun 21;4(2):111-116. doi: 10.22603/ssrr.2019-0038. eCollection 2020.
The current communication seeks to provide an updated narrative review on latest methods of reducing implant contaminations used during spine surgery. Recent literature review has shown that both preoperative reprocessing and intraoperative handling of implants seem to contaminate implants. In brief, during preoperative phase, the implants undergo repeated bulk cleaning with dirty instruments from the OR, leading to residue buildup at the interfaces and possibly on the surfaces too. This, due to its concealed nature, remains unnoticed by the SPD (sterile processing department) or other hospital staff. Nevertheless, these can be avoided by using individually prepackaged presterilized implants. In the intraoperative phase, the implants (in the sterile field) are directly touched by the scrub tech with soiled (assisting the surgeon dispose the tissues from the instruments in use) gloves for loading onto an insertion device. It is then kept exposed on the working table (either separately or next to the used instruments as the pedicles hole are being prepared). Latest investigation has shown that by the time it is implanted in the patient, it can harbor up to 10e7 bacterial colony-forming units. The same implants were devoid of such colony-forming units, when sheathed by an impermeable sterile sheath around the sterile implant.
本通讯旨在提供一篇最新的叙述性综述，介绍脊柱手术中减少植入物污染的最新方法。最近的文献综述表明，植入物的术前再处理和术中操作似乎都会导致植入物受到污染。简而言之，在术前阶段，植入物会与手术室的脏器械一起进行反复的批量清洁，导致界面处甚至表面也会有残留物堆积。由于其隐蔽性，消毒供应部门（SPD）或其他医院工作人员并未注意到这一点。然而，使用单独预包装的预灭菌植入物可以避免这些问题。在术中阶段，无菌区域内的植入物会被刷手技术员戴着脏手套（协助外科医生处理使用中的器械上的组织）直接触摸，以便装载到插入装置上。然后将其暴露在工作台上（单独放置或在准备椎弓根孔时放在用过的器械旁边）。最新研究表明，在植入患者体内时，它可能携带多达10的7次方个细菌菌落形成单位。当在无菌植入物周围包裹一层不透水的无菌护套时，同样的植入物则没有此类菌落形成单位。
