Hovis James P, Moore-Lotridge Stephanie N, Mansour Ashton, Gibson Breanne H Y, Weikert Douglas R, Desai Mihir J, Gebhart Sandra S, Schoenecker Jonathan G, Lee Donald H
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Department of Pharmacology, Vanderbilt University, Robinson Research, Nashville, Tennessee, United States.
J Hand Microsurg. 2020 Jul 26;14(2):153-159. doi: 10.1055/s-0040-1714434. eCollection 2022 Apr.
Previous studies have demonstrated that sterile equipment is frequently contaminated intraoperatively, yet the incidence of miniature c-arm (MCA) contamination in hand and upper extremity surgery is unclear. To examine this incidence, a prospective study of MCA sterility in hand and upper extremity cases was performed in a hospital main operating room (MOR) ( = 13) or an ambulatory surgery center operating room (AOR) ( = 16) at a single tertiary care center. Case length, MCA usage parameters, and sterility of the MCA through the case were examined. We found that MOR surgical times trended toward significance ( = 0.055) and that MOR MCAs had significantly more contamination prior to draping than AOR MCAs ( < 0.001). In MORs and AORs, 46.2 and 37.5% of MCAs respectively were contaminated intraoperatively. In MORs and AORs, 85.7 and 80% of noncontaminated cases, respectively, used the above hand- table technique, while 50 and 83.3% of contaminated MOR and AOR cases, respectively, used a below hand-table technique. Similar CPT codes were noted in both settings. Thus, a high-rate of MCA intraoperative contamination occurs in both settings. MCA placement below the hand-table may impact intraoperative contamination, even to distant MCA areas. Regular sterilization of equipment and awareness of these possible risk factors could lower bacterial burden.
以往研究表明，无菌设备在手术过程中常被污染，但手部及上肢手术中微型C形臂（MCA）的污染发生率尚不清楚。为了研究这一发生率，在一家三级医疗中心的医院主手术室（MOR）（n = 13）或门诊手术中心手术室（AOR）（n = 16）对MCA在手部及上肢手术中的无菌情况进行了一项前瞻性研究。检查了病例时长、MCA使用参数以及整个病例过程中MCA的无菌情况。我们发现，MOR的手术时间有显著趋势（P = 0.055），且MOR的MCA在铺巾前的污染明显多于AOR的MCA（P < 0.001）。在MOR和AOR中，分别有46.2%和37.5%的MCA在术中被污染。在MOR和AOR中，未被污染的病例分别有85.7%和80%采用了上述手台上方技术，而MOR和AOR中被污染的病例分别有50%和83.3%采用了手台下方技术。两种情况下的CPT编码相似。因此，在这两种情况下MCA术中污染率都很高。将MCA放置在手台下方可能会影响术中污染，甚至对较远的MCA区域也有影响。定期对设备进行消毒并了解这些可能的风险因素可以降低细菌负荷。
