University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Sweden; Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Sweden.
School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Sweden; Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Sweden.
J Hosp Infect. 2021 Apr;110:97-102. doi: 10.1016/j.jhin.2021.01.016. Epub 2021 Jan 28.
Surgical site infections are a global patient safety concern. Due to lack of evidence on contamination, pre-set surgical goods are sometimes disposed of or re-sterilized, thus increasing costs, resource use, and environmental effects.
To investigate time-dependent bacterial air contamination of covered and uncovered sterile goods in the operating room.
Blood agar plates (N = 1584) were used to detect bacterial air contamination of sterile fields on 48 occasions. Each time, three aerobe and three anaerobe plates were used as baseline to model the preparation time, and 60 (30 aerobe, 30 anaerobe) were used to model the time pending before operation; half of these were covered with sterile drapes and half remained uncovered. Plates were collected after 4, 8, 12, 16, and 24 h.
Mean time before contamination was 2.8 h (95% confidence interval: 2.1-3.4) in the uncovered group and 3.8 h (3.2-4.4) in the covered group (P = 0.005). The uncovered group had 98 colony-forming units (cfu) versus 20 in the covered group (P = 0.0001). Sixteen different micro-organisms were isolated, the most common being Cutibacterium acnes followed by Micrococcus luteus. Of 32 Staphylococcus cfu, 14 were antibiotic resistant, including one multidrug-resistant Staphylococcus epidermidis.
Protecting sterile fields from bacterial air contamination with sterile covers enhances the durability of sterile goods up to 24 h. Prolonged durability of sterile goods might benefit patient safety, since surgical sterile material could be prepared in advance for acute surgery, thereby enhancing quality of care and reducing both climate impact and costs.
手术部位感染是全球关注的患者安全问题。由于缺乏污染方面的证据，有时会丢弃或重新消毒预先设定的手术用品，从而增加成本、资源利用和环境影响。
调查手术室覆盖和未覆盖的无菌物品的细菌空气污染随时间的变化情况。
在 48 次情况下，使用血琼脂平板（N=1584）检测无菌区域的细菌空气污染。每次均使用三个需氧和三个厌氧菌平板作为基线来模拟准备时间，并使用 60 个（30 个需氧，30 个厌氧菌）来模拟手术前的等待时间；其中一半用无菌巾覆盖，一半未覆盖。在 4、8、12、16 和 24 小时后收集平板。
未覆盖组污染前的平均时间为 2.8 小时（95%置信区间：2.1-3.4），覆盖组为 3.8 小时（3.2-4.4）（P=0.005）。未覆盖组有 98 个菌落形成单位（cfu），而覆盖组有 20 个（P=0.0001）。共分离出 16 种不同的微生物，最常见的是痤疮丙酸杆菌，其次是微球菌。32 个金黄色葡萄球菌 cfu 中有 14 个是抗生素耐药的，包括一个耐多药表皮葡萄球菌。
用无菌罩保护无菌区域免受细菌空气污染，可以使无菌物品的耐用性延长至 24 小时。无菌物品耐用性的延长可能有利于患者安全，因为可以提前为急性手术准备外科无菌材料，从而提高护理质量，减少气候影响和成本。
