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Tsay EL, Sabharwal S. Reuse of Orthopaedic Equipment: Barriers and Opportunities. JBJS Rev 2024; 12:01874474-202403000-00005. [PMID: 38466800 DOI: 10.2106/jbjs.rvw.23.00117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
» Reuse of orthopaedic equipment is one of many potential ways to minimize the negative impact of used equipment on the environment, rising healthcare costs and disparities in access to surgical care.» Barriers to widespread adoption of reuse include concerns for patient safety, exposure to unknown liability risks, negative public perceptions, and logistical barriers such as limited availability of infrastructure and quality control metrics.» Some low- and middle-income countries have existing models of equipment reuse that can be adapted through reverse innovation to high-income countries such as the United States.» Further research should be conducted to examine the safety and efficacy of reusing various orthopaedic equipment, so that standardized guidelines for reuse can be established.
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Affiliation(s)
- Ellen L Tsay
- University of California, San Francisco, San Francisco, California
| | - Sanjeev Sabharwal
- University of California, San Francisco, San Francisco, California
- UCSF Benioff Children's Hospital Oakland, Oakland, California
- Institute of Global Orthopaedics and Traumatology, San Francisco, California
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Land V, Dickerson S, Goldman A, Shirley ED. The Surgical Instrument Sterilization Process: What Every Surgeon Should Know. JBJS Rev 2023; 11:01874474-202311000-00008. [PMID: 38015592 DOI: 10.2106/jbjs.rvw.23.00131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
» The phases of the sterilization process for surgical equipment are cleaning, disinfection, and sterilization.» Following manufacturer and regulatory guidelines will minimize contamination throughout the sterilization process.» Immediate use steam sterilization, when used appropriately, is a reasonably safe option to be used at the discretion of the operating surgeon.
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Affiliation(s)
- Vaughn Land
- Naval Medical Center Portsmouth, Portsmouth, Virginia
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Rutala WA, Weber DJ. Risk of disease transmission to patients from "contaminated" surgical instruments and immediate use steam sterilization. Am J Infect Control 2023; 51:A72-A81. [PMID: 37890956 DOI: 10.1016/j.ajic.2023.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND There are several sources of pathogens that cause surgical site infections (SSI) to include the patients endogenous microflora and exogenous sources (e.g., air, surfaces, staff, surgical equipment). METHODS We searched the published English literature (Google, Google Scholar, PubMed) for articles on reprocessing surgical instruments, effectiveness of sterilization methods, microbial load on surgical instruments, frequency of "contaminated" instruments, and the infection risk associated with "contaminated" surgical instruments and immediate use steam sterilization. RESULTS There is substantial redundancy in instrument reprocessing to include: even if a patient was exposed to a "contaminated" instrument, the decontamination and sterilization process would have removed and/or inactivated the contaminating pathogens due to the exceptional effectiveness of the manual and mechanical cleaning (i.e., washer-disinfector) and the remarkable robustness of sterilization technology; and the low-level of microorganisms on surgical instruments after use and before cleaning. CONCLUSIONS A critical review of the literature suggests that the risk of acquiring an SSI from instruments used in surgery is essentially zero if the sterilization cycle is validated.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
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Evangelista SDS, Santos SGD, Oliveira ACD. Impact of the contamination time by Escherichia coli on biofilm formation in surgical instruments. Rev Bras Enferm 2021; 74:e20200759. [PMID: 34287490 DOI: 10.1590/0034-7167-2020-0759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to evaluate the microbial load and adherence of Escherichia coli in different areas of the surgical instrument surface exposed to experimental contamination over time. METHODS experimental study in which fragments of crile forceps (serrated, rod and rack) were contaminated by immersion in Tryptic Soy Broth, containing 106 CFU/mL of E. coli, for 1, 2, 4, 6, 8, 12 and 24 hours. Microbial load and bacterial adherence were evaluated using microbiological culture and scanning electron microscopy, respectively. RESULTS there was an increase in the microbial load on the surgical instrument, proportional to the contamination interval, ranging from 102 after 1 hour to 105 CFU/cm2 in 24 hours. The presence of exopolysaccharide was detected after two hours of contamination. CONCLUSIONS microbial load and adhesion of E. coli increased over time, reaching 105 CFU/cm2 after 24 hours of contamination, starting biofilm formation after two hours.
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Wright R, Seeman K. Clinical Issues-July 2021. AORN J 2021; 114:87-94. [PMID: 34181255 DOI: 10.1002/aorn.13433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/11/2022]
Abstract
Debris in sterilized instrument sets Key words: organic debris, inorganic debris, instrument sets, sterile processing, sterilizing agent. Preventing debris in sterilized instrument sets Key words: debris, instrument sets, sterile processing equipment, instructions for use (IFU), quality assurance. Bone cement precautions during pregnancy Key words: bone cement, exposure, methyl methacrylate (MMA), pregnant. Using a bed sheet or blanket for positioning Key words: patient positioning devices, improvised positioning device, pressure distribution, skin shear, pressure injury. Laundering of cloth head coverings Key words: laundering, head covering, reusable cloth hat, surgical attire, disposable bouffant.
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Schömig F, Perka C, Pumberger M, Ascherl R. Implant contamination as a cause of surgical site infection in spinal surgery: are single-use implants a reasonable solution? - a systematic review. BMC Musculoskelet Disord 2020; 21:634. [PMID: 32977778 PMCID: PMC7519515 DOI: 10.1186/s12891-020-03653-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023] Open
Abstract
Background In spine surgery, surgical site infection (SSI) is one of the main perioperative complications and is associated with a higher patient morbidity and longer patient hospitalization. Most factors associated with SSI are connected with asepsis during the surgical procedure and thus with contamination of implants and instruments used which can be caused by pre- and intraoperative factors. In this systematic review we evaluate the current literature on these causes and discuss possible solutions to avoid implant and instrument contamination. Methods A systematic literature search of PubMed addressing implant, instrument and tray contamination in orthopaedic and spinal surgery from 2001 to 2019 was conducted following the PRISMA guidelines. All studies regarding implant and instrument contamination in orthopaedic surgery published in English language were included. Results Thirty-five studies were eligible for inclusion and were divided into pre- and intraoperative causes for implant and instrument contamination. Multiple studies showed that reprocessing of medical devices for surgery may be insufficient and lead to surgical site contamination. Regarding intraoperative causes, contamination of gloves and gowns as well as contamination via air are the most striking factors contributing to microbial contamination. Conclusions Our systematic literature review shows that multiple factors can lead to instrument or implant contamination. Intraoperative causes of contamination can be avoided by implementing behavior such as changing gloves right before handling an implant and reducing the instruments’ intraoperative exposure to air. In avoidance of preoperative contamination, there still is a lack of convincing evidence for the use of single-use implants in orthopaedic surgery.
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Affiliation(s)
- Friederike Schömig
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Rudolf Ascherl
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Rodriguez JA, Hooper G. Adenosine Triphosphate-Bioluminescence Technology as an Adjunct Tool to Validate Cleanliness of Surgical Instruments. AORN J 2020; 110:596-604. [PMID: 31774154 DOI: 10.1002/aorn.12864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Perioperative and sterile processing department personnel commonly use visual inspection to validate surgical instrument cleanliness. This validation process does not detect microbes (eg, bacteria, viruses) and the resultant inadequately decontaminated instruments can put patients at risk for developing surgical site infections. Sterile processing department personnel should use a rapid, straightforward method to validate surgical instrument cleanliness objectively. During a quality improvement project at a military treatment facility, staff members found that adenosine triphosphate (ATP)-based technology was a viable and affordable solution for detecting bioburden and validating cleaning practices. The project design compared manually and mechanically cleaned cannulated instruments (59 of each) and identified 16 contaminated instruments, 14 of which had been manually cleaned. The contamination rate after mechanical cleaning was significantly lower (P = .0022) compared with manual cleaning. As a result of this quality improvement project, this facility fully implemented the technology to validate instrument cleaning.
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Liang P, Zhao G, Gu X, Chen Z, Xu S, Lai W, Liu W. Assessment of arthroscopic shavers: a comparison test of resection performance and quality. J Orthop Surg Res 2020; 15:62. [PMID: 32085784 PMCID: PMC7033941 DOI: 10.1186/s13018-020-01596-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Arthroscopic shavers play an indispensable role in arthroscopic debridement. They have exquisite structures and similar designs. The purpose of this study was to establish a reproducible testing protocol to compare the resection performance and the quality (tensile strength, torsional strength, and corrosion resistance) of different arthroscopic shavers with comparable designs. We hypothesized that there could be little difference in resection performance and quality between these shavers. Methods Incisor Plus Blade (IPB; Smith & Nephew, Andover, MA) and Double Serrated Plus Blade (DSPB; BJKMC, Shanghai, China) were selected for resection performance and quality test. For resection performance testing, the resection torque, which is the minimum torque required to cut off silicone blocks with the same cross-sectional area, was measured to evaluate the resection performance of shaver blades when the other factors remain the same. For quality testing, tensile and torsion tests of the shavers’ joint part were performed, and ultimate failure load and maximum torque were measured and compared. The corrosion resistance of these blades was assessed by the boiling water test based on the ISO13402. Results No significant difference existed in the resection torque between the shaver blades of IPB and DSPB (P = 0.54). To the failure load of shavers’ joint parts, IPB was significantly higher than DSPB, both in the outer and inner blades (P < 0.0001). The maximum torque of the joint part had no significant difference between IPB and DSPB (for inner blades P = 0.60 and outer blades P = 0.94). The failure load (for both IPB and DSPB P < 0.0001) and maximum torque (for IPB P = 0.0475 and DSPB P = 0.015) of the inner blades were higher than those of the outer blades. No blemishes were observed on the surface of the blades after corrosion resistance tests. Conclusions This study provided some new methods to evaluate the resection performance and quality of different shavers. The resection performance, the torsional strength of the joint part, and the corrosion resistance of IPB and DSPB may show comparable properties, whereas the tensile strength of the shavers’ joint part showed some level of difference.
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Affiliation(s)
- Peng Liang
- Department of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Gaiping Zhao
- Department of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.
| | - Xuelian Gu
- Department of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhi Chen
- Shanghai BJ-KMC Medical Technology Co., Ltd., Shanghai, China
| | - Shaorong Xu
- Shanghai BJ-KMC Medical Technology Co., Ltd., Shanghai, China
| | - Weiguo Lai
- Shanghai Ligetai Biotechnology Co., Ltd., Shanghai, China
| | - Wentao Liu
- Department of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Resendiz M, Horseman TS, Hover AJ, Bradley DF, Lustik MB, West GF. Assessment of surgical instrument bioburden after steam sterilization: A pilot study. Am J Infect Control 2020; 48:219-221. [PMID: 31604619 DOI: 10.1016/j.ajic.2019.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 11/26/2022]
Abstract
In environments in which manual decontamination and steam sterilization remains the primary method of sterilization, biofilm formation can increase the risk of disease transmission. To determine the risk of bacterial survival and contamination on surgical instruments, inoculated blood was dried on one instrument and steam sterilized (wrapped or unwrapped) in a set of 4 (including 3 clean). Two of 3 pathogens were recovered at a rate of 15% for unwrapped sets and 33% for wrapped sets.
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Medical instrument reprocessing: current issues with cleaning and cleaning monitoring. Am J Infect Control 2019; 47S:A10-A16. [PMID: 31146843 DOI: 10.1016/j.ajic.2019.02.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The complexity of medical devices has increased over the past 10 years, and outbreaks of infections due to contaminated devices have focused attention on the need to adequately clean medical devices in order to ensure the adequacy of disinfection and sterilization. There has been a paradigm shift in reprocessing of medical devices, with increased emphasis on a quality management systems approach that requires validated cleaning instructions from manufacturers and ongoing monitoring by reprocessing personnel to ensure adequacy of cleaning. This article reviews the current issues related to medical device reprocessing and summarizes the approaches used for monitoring cleaning efficacy for surgical instruments and flexible endoscopes.
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Capuder K, Gill C, Hafez J, Kawalec J, Hetherington V. Effect of repeated cycles of steam sterilization on the integrity of cannulated surgical screws. Foot (Edinb) 2019; 39:88-91. [PMID: 30981129 DOI: 10.1016/j.foot.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/05/2019] [Accepted: 02/27/2019] [Indexed: 02/04/2023]
Abstract
The process of repeated handling and steam sterilization of bone screws and allows debris to deposit on the surface and inside cannulated screws. Individually packaged screws could alleviate these potential problems. This research intended to evaluate the effect that multiple cycles of sterilization may have, if any, on the mechanical integrity of cannulated screws. The results indicate that the mechanical integrity of the screws tested was not compromised.
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Affiliation(s)
- Kelly Capuder
- Kent State University College of Podiatric Medicine, United States
| | - Christopher Gill
- Kent State University College of Podiatric Medicine, United States
| | - Jawdat Hafez
- Kent State University College of Podiatric Medicine, United States
| | - Jill Kawalec
- Kent State University College of Podiatric Medicine, United States
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Lopes LKO, Costa DM, Tipple AFV, Watanabe E, Castillo RB, Hu H, Deva AK, Vickery K. Complex design of surgical instruments as barrier for cleaning effectiveness, favouring biofilm formation. J Hosp Infect 2018; 103:e53-e60. [PMID: 30423413 DOI: 10.1016/j.jhin.2018.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/02/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Inadequately reprocessed reusable surgical instruments (RSIs) may harbour infectious agents which may then be transferred to a suitable site for replication. AIM To determine the cumulative effect of 20 cycles of contamination, cleaning (manual or manual followed by automated) and steam sterilization on high-complex-design RSIs used for orthopaedic surgery. METHODS New flexible medullary reamers and depth gauges were contaminated by soaking in tryptone soya broth, containing 5% sheep blood and 109 cfu/mL of Staphylococcus aureus (ATCC 25923), for 5 min. To mimic a worse-case scenario, RSIs were dried 7 h and subjected to either (a) rinsing in distilled water, (b) manual cleaning or (c) manual plus automated cleaning (reference standard), and steam sterilization. The contamination, cleaning, and sterilization cycle was repeated 20 times. Adenosine triphosphate (ATP) was measured after cleaning procedures; microbial load and residual protein were measured following the 10th and 20th reprocessing, in triplicate. Scanning electron microscopy (SEM) was used to confirm soil and biofilm presence on the RSIs after the 20th reprocessing. FINDINGS Manual and manual plus automated cleaning significantly reduced the amount of ATP and protein residues for all RSIs. Viable bacteria were not detected following sterilization. However, SEM detected soil after automated cleaning, and soil, including biofilms, after manual cleaning. CONCLUSION Soil and/or biofilms were evident on complex-design RSIs following 20 cycles of contamination and reprocessing, even using the reference standard method of cleaning. Although the depth gauges could be disassembled, biological residues and biofilm accumulated in its lumen. The current design of these RSIs prevents removal of all biological soil and this may have an adverse effect on patient outcome.
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Affiliation(s)
- L K O Lopes
- Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil; Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - D M Costa
- Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil; Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - A F V Tipple
- Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil
| | - E Watanabe
- School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - R B Castillo
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - H Hu
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - A K Deva
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - K Vickery
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
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