Altınayak Harun, Öner Sedef Zeliha, Özdemir Süleyman
Department of Orthopedics and Traumatology, Samsun Training and Research Hospital, Health Sciences University, Samsun, Turkey.
Department of Medical Microbiology, Pamukkale University, School of Medicine, Çamlaraltı, Pamukkale Ünv. Hastane Yolu, Pamukkale/Denizli , 20070, Turkey.
Eur J Orthop Surg Traumatol. 2022 Apr;32(3):459-465. doi: 10.1007/s00590-021-02978-2. Epub 2021 May 20.
This study aims to determine the contamination incidence rate of bone fragments that have been dropped on the floor of the operating theatre, as well as how effective antimicrobial solutions are at decontaminating them.
Bone fragments obtained after 30 total knee arthroplasties were used in the study. Inert pieces of bone emerging after the bone cuts during total knee arthroplasty were divided into 1 × 1 cm fragments. The bone fragments were first left in free fall on the floor of the operating theatre and then were kept in a number of antimicrobial solutions for 15 s. Subsequently, they were microbiologically and histopathologically examined. A swab culture was also taken from the floor of the operating theatre.
It was determined that 63.3% of osteochondral fragments in the non-intervened group were contaminated. Growth was likewise detected in all swab cultures. Microorganisms growing in the swab culture and the non-intervened group were similar and mostly Staphylococcus epidermidis and Klebsiella pneumoniae. When the growth rates of the 10% povidone-iodine and 4% chlorhexidine gluconate groups were compared with the growth rate of the non-intervened group, a statistical difference was found. No difference was determined between the growth rates of the sodium hypochlorite and the non-intervened groups. The histopathological analysis revealed no statistical difference between the groups in terms of bone marrow, vascular structure, fat tissue, and osteoblastic activity results in the osteochondral fragments CONCLUSION: Bone tissues dropped from a sterile area on the floor of the operating theatre are highly contaminated. An effective decontamination without bone cell toxicity was achieved using povidone-iodine. Although chlorhexidine gluconate solution had an effective decontamination effect compared to the non-intervened group, it was not 100% effective. Sodium hypochlorite solution was not effective in the decontamination of grafts under our working conditions.
本研究旨在确定掉落在手术室地面的骨碎片的污染发生率，以及抗菌溶液对其进行去污的效果如何。
本研究使用了30例全膝关节置换术后获得的骨碎片。全膝关节置换术中截骨后出现的惰性骨块被切成1×1厘米的碎片。骨碎片首先自由掉落在手术室地面，然后在多种抗菌溶液中浸泡15秒。随后，对其进行微生物学和组织病理学检查。还从手术室地面采集了拭子培养物。
确定未干预组中63.3%的骨软骨碎片被污染。在所有拭子培养物中也检测到了生长。拭子培养物和未干预组中生长的微生物相似，主要是表皮葡萄球菌和肺炎克雷伯菌。将10%聚维酮碘组和4%葡萄糖酸氯己定组的生长率与未干预组的生长率进行比较时，发现有统计学差异。次氯酸钠组和未干预组的生长率之间未发现差异。组织病理学分析显示，在骨软骨碎片的骨髓、血管结构、脂肪组织和成骨细胞活性结果方面，各组之间没有统计学差异。
从无菌区域掉落在手术室地面的骨组织受到高度污染。使用聚维酮碘可实现无骨细胞毒性的有效去污。尽管与未干预组相比，葡萄糖酸氯己定溶液具有有效的去污效果，但并非100%有效。在我们的工作条件下，次氯酸钠溶液对移植物的去污无效。
