Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Foot Ankle Int. 2021 Aug;42(8):994-1001. doi: 10.1177/10711007211001032. Epub 2021 Mar 31.
Many orthopedic surgeries utilize intraoperative fluoroscopy. The mini C-arm is an advantageous device as it can be easily used without the need for a dedicated radiology technician. However, there are concerns that the mini C-arm may represent a potential source of contamination and subsequent postoperative infection. Previous investigations of standard C-arm drapes have shown high rates of contamination. Similar contamination rates would be even more concerning for the mini C-arm as it requires physically maneuvering the machine. This study aimed to determine the rate of mini C-arm drape contamination and identify high-risk areas.
Fifty foot and ankle surgeries requiring the use of mini C-arm fluoroscopy were included. Eight locations on the mini C-arm drape were sampled at the conclusion of each procedure. Culture Q-swabs were used for sampling defined locations. Swab samples were then assessed for bacterial growth on a 5% blood agar plate using a semiquantitative technique.
In 70% of surgical cases, contamination was observed in at least 1 location. Six of the 8 evaluated locations were found to have significantly higher contamination in comparison with their corresponding negative controls (Mann-Whitney test, < .05). The "outer portion of the upper arm" (location 1) exhibited bacteria growth in 26% ( < .0001) of cases. The "superior portion of the x-ray source" (location 2) exhibited growth in 30% ( .0001) of cases. These were the highest-risk areas for contamination and were both significantly more likely to be involved than the "inferior portion of the x-ray source" and "superior portion of the beam receiver," locations 4 and 5, respectively. Fourteen percent (7/50) C-arm cases and 1.72% (1/58) Achilles tendon surgery control cases developed surgical site infection ( = .0234; OR, 9.27).
Bacterial contamination of the mini C-arm drape was found to be common after foot and ankle procedures. Contamination was more prevalent on the outer ring areas of the C-arm, both at the emitter and receiver.
Level III, prospective cohort study.
许多骨科手术都需要术中透视。微型 C 臂是一种有利的设备，因为它可以很容易地使用，而不需要专门的放射技师。然而，人们担心微型 C 臂可能是污染和随后术后感染的潜在来源。先前对标准 C 臂帷幕的调查显示，污染率很高。如果微型 C 臂的污染率类似，那将更加令人担忧，因为它需要实际操作机器。本研究旨在确定微型 C 臂帷幕污染率，并确定高风险区域。
纳入了 50 例需要使用微型 C 臂透视的足部和踝关节手术。在每个手术结束时，对微型 C 臂帷幕的 8 个位置进行采样。使用 Culture Q 拭子对定义的位置进行采样。使用半定量技术，在 5%血琼脂平板上评估拭子样本的细菌生长情况。
在 70%的手术病例中，至少有 1 个位置观察到污染。与相应的阴性对照相比，8 个评估位置中有 6 个位置的污染明显更高（Mann-Whitney 检验， <.05）。“上臂外部分”（位置 1）在 26%（ <.0001）的病例中出现细菌生长。“射线源上部”（位置 2）在 30%（.0001）的病例中出现生长。这是污染的最高风险区域，与“射线源下部”和“射线接收器上部”（位置 4 和 5）相比，这些区域更有可能受到污染。14%（7/50）的 C 臂病例和 1.72%（1/58）的跟腱手术对照组出现手术部位感染（ =.0234；OR，9.27）。
在足部和踝关节手术后，发现微型 C 臂帷幕的细菌污染很常见。污染更常见于 C 臂的外环区域，包括发射器和接收器。
三级，前瞻性队列研究。
