Department of Orthopedics, University of Connecticut, Farmington, CT, USA.
Department of Orthopedics, University of Connecticut, Farmington, CT, USA.
J Hosp Infect. 2022 Dec;130:52-55. doi: 10.1016/j.jhin.2022.08.010. Epub 2022 Sep 8.
Macroscopic contamination of orthopaedic instruments with particulates, including cortical bone and polymethyl methacrylate (PMMA) bone cement, that have previously undergone pre-operative sterilization is frequently encountered peri- or intraoperatively, calling into question the sterility of such instruments.
To determine if macroscopic contaminants of orthopaedic surgical instrumentation maintain a bacterial burden following sterile processing, and to determine the most commonly contaminated instruments and the most common contaminants.
Macroscopic contaminants in orthopaedic instrument trays were collected prospectively at a single tertiary referral centre over a 6-month period from August 2021 to May 2022. When identified, these specimens were swabbed and plated on sheep blood agar. All specimens were incubated at 37 °C for 14 days, and inspected visually for colony formation. When bacterial colony formation was identified, samples were sent for species identification.
In total, 33 contaminants were tested, and only one contaminant was found to be growing bacterial colonies (Corynebacterium sp.). The items most commonly found to have macroscopic contamination were surgical trays (N=9) and cannulated drills (N=7). The identifiable contaminants were bone (N=10), PMMA bone cement (N=4) and hair (N=4). Eleven macroscopic contaminants were not identifiable.
This study found that 97% of macroscopic orthopaedic surgical instrument contaminants that underwent sterile processing did not possess a bacterial burden. Contaminants discovered during a procedure are likely to be sterile, and do not pose a substantially increased risk of infection to a patient.
在骨科手术器械中，经常会遇到先前经过术前灭菌的微粒状物质（包括皮质骨和聚甲基丙烯酸甲酯（PMMA）骨水泥）的宏观污染，这在围手术期或手术期间引起了对这些器械无菌性的质疑。
确定骨科手术器械的宏观污染物在经过无菌处理后是否仍保持细菌负担，并确定最常污染的器械和最常见的污染物。
在 2021 年 8 月至 2022 年 5 月的 6 个月期间，在一家单一的三级转诊中心前瞻性地收集骨科器械托盘上的宏观污染物。当发现这些标本时，对其进行拭子采样并接种在绵羊血琼脂上。所有标本均在 37°C 下孵育 14 天，并观察其是否有菌落形成。当确认有细菌菌落形成时，将样本送去进行种属鉴定。
总共测试了 33 个污染物，只有一个污染物被发现生长有细菌菌落（棒状杆菌属）。最常见的具有宏观污染的器械是手术托盘（9 个）和带套管的钻头（7 个）。可识别的污染物是骨（10 个）、PMMA 骨水泥（4 个）和毛发（4 个）。11 个宏观污染物无法识别。
本研究发现，经过无菌处理的 97%骨科手术器械宏观污染物没有细菌负担。手术过程中发现的污染物可能是无菌的，不会对患者造成明显增加的感染风险。
