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Kim SH, Jang SY, Cha Y, Kim BY, Lee HJ, Kim GO. Analysis of the effects of intraoperative warming devices on surgical site infection in elective hip arthroplasty using a large nationwide database. Arch Orthop Trauma Surg 2023; 143:7237-7244. [PMID: 37500931 DOI: 10.1007/s00402-023-04917-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/21/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION The aim of our study is to analyze the association of usage and type of warming device with the risk of surgical site infection (SSI) in patients who underwent hip arthroplasty, and to analyze the factors that increase the risk of SSI if the warming device is not used. MATERIALS AND METHODS This retrospective cross-sectional study identified subjects from data of "Evaluation of the Appropriate Use of Prophylactic Antibiotics". Included patients were defined as those who underwent elective unilateral hip hemiarthroplasty or total hip arthroplasty (THA). Patients were classified into no intraoperative warming device, forced air warming devices, and devices using conduction. Multiple logistic regression analysis was conducted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to assess the association between warming devices and SSI. RESULTS A total of 3945 patients met the inclusion criteria. Compared to those who received an intraoperative warming device, the odds of developing SSI were 1.9 times higher in those who did not receive intraoperative warming devices (aOR 1.9; 95% CI 1.1-3.6). The risk of SSI was 2.2 times higher with forced air warming devices compared to devices using conduction but this difference was not statistically significant (aOR 2.2; 95% CI 0.7-6.8). The risk of SSI increased in males (aOR 2.8; 95% CI 1.1-7.2), in patients under 70 years of age (aOR 4.4; 95% CI 1.6-10.4), in patients with a Charlson`s comorbidity index of 2 or higher (aOR 3.3; 95% CI 1.3-8.7), and in patients who underwent THA (aOR 3.8; 95% CI 1.7-8.3) when intraoperative warming devices were not used. CONCLUSIONS The use of intraoperative active warming devices is highly recommended to prevent SSI during elective hip arthroplasty. In particular, male patients younger than 70 years, those with a high CCI, and those undergoing THA are at significantly increased risk of SSI if intraoperative active warming devices are not used. Intraoperative warming device using conduction is likely superior to forced air warming device, but further studies are needed to confirm this.
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Affiliation(s)
- Seung Hoon Kim
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, South Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 95 Dunsan Seoro, Seo-Gu, Daejeon, 35233, South Korea.
| | - Bo-Yeon Kim
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Hyo-Jung Lee
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Gui-Ok Kim
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, South Korea
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Fickenscher MC, Stewart M, Helber R, Quilligan EJ, Kreitenberg A, Prietto CA, Gardner VO. Operating room disinfection: operator-driven ultraviolet 'C' vs. chemical treatment. Infect Prev Pract 2023; 5:100301. [PMID: 37575675 PMCID: PMC10412461 DOI: 10.1016/j.infpip.2023.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Background In operating room (OR) surfaces, Nosocomial pathogens can persist on inanimate surfaces for long intervals and are highly resistant to traditional surface cleaning. Aim This study compares traditional chemical operating room terminal disinfection to a unique operator-driven device that emits germicidal UV light at short distance onto vertical and horizontal surfaces. Methods A randomized crossover analogous protocol assigned 40 end-of-day operating rooms into either group A (chemical then UVC treatments) or group B (UVC then chemical treatments). Initial Staphylococcal cultures were obtained prior to disinfection treatment, after the first treatment, and after the second treatment at 16 most commonly contaminated sites to represent overall room contamination. Success was defined as no growth and failure as 1 or more colony forming units. Thoroughness of chemical treatment vs UVC treatment was compared and used to determine if the second treatment was additive to the first treatment within each group. Findings The operator driven UVC device outperformed chemical treatment in reducing the number of contaminated sites in the OR by more than half (P<0.001). Operator-driven UVC reduced contaminated sites after chemical treatment by nearly half (P<0.001). In contrast, chemical treatment after operator-driven UVC did not significantly reduce the number of contaminated sites. The mean employee time of disinfection for chemical treatment was 49 minutes and for the operator-driven UVC emitter 7.9 minutes (P<0.001). Conclusions This study demonstrates that addition of an operator-driven UVC emitter to OR rooms between cases could be helpful in overall decreasing the number of contaminated sites.
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Affiliation(s)
| | - Madeline Stewart
- Hoag Orthopedics Education and Research, Hoag Orthopedic Institute, Irvine, CA, United States
| | - Ryan Helber
- Hoag Orthopedics Education and Research, Hoag Orthopedic Institute, Irvine, CA, United States
| | - Edward J. Quilligan
- Hoag Orthopedics Education and Research, Hoag Orthopedic Institute, Irvine, CA, United States
| | - Arthur Kreitenberg
- Department of Orthopedic Surgery, Center for Orthopedic & Sports Excellence, Los Angeles, CA, United States
| | - Carlos A. Prietto
- Hoag Orthopedics Education and Research, Hoag Orthopedic Institute, Irvine, CA, United States
| | - Vance O. Gardner
- Hoag Orthopedics Education and Research, Hoag Orthopedic Institute, Irvine, CA, United States
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Tammelin A, Kylmänen P, Samuelsson A. Comparison of number of air-borne bacteria in operating rooms with turbulent mixing ventilation and unidirectional airflow when using reusable scrub suits and single-use scrub suits. J Hosp Infect 2023; 135:119-124. [PMID: 36963617 DOI: 10.1016/j.jhin.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Low counts of air-borne bacteria in the operating room is a mean to prevent surgical site infection. AIM To investigate levels of air-borne bacteria during surgical procedures in two operating rooms with turbulent mixing ventilation (TMV) and unidirectional airflow (UDAF), both with an air supply of 2600 L/s, when staff used either reusable scrub suits made from a mixed material (dry penetration ≤ 300 CFU) or single-use scrub suits made from polypropylene (dry penetration ≤ 100 CFU). MATERIAL AND METHODS In the TMV-room colony forming units (CFU) per m3 air was measured during eight procedures with staff wearing reusable scrub suits and seven procedures with single-use scrub. In the UDAF-room CFU/m3 air was measured during seven procedures with staff wearing reusable scrub suits. FINDINGS Mean values of CFU/m3 air were 1.3 to 10.8 in the TMV-room with staff dressed in reusable scrub suits and 0.8 to 4.0 with staff dressed in single-use scrub suits (p < 0.01). Mean values of CFU/m3 air were 0.2 to 4.5 in the UDAF-room with staff dressed in reusable scrub suits. The difference obtained with reusable scrub suits in the two rooms was significant (p < 0.01). CONCLUSIONS The mode of ventilation affects the CFU-levels when staff is dressed in less occlusive scrub suits despite a high air supply. It is possible to decrease the CFU-levels in a TMV-room by using scrub suits made from a tight material thus reaching the same levels that are achieved by less protective scrub suits in a UDAF-room.
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Affiliation(s)
- Ann Tammelin
- Department of Medicine, Solna (MedS), Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
| | - Päivi Kylmänen
- Perioperative Medicine and Intensive Care, Karolinska University Hospital Huddinge, Sweden
| | - Anders Samuelsson
- Department of Medicine, Solna (MedS), Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
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Harp JH. Observational Study of Sterile Field Bioburden Levels During Orthopedic Arthroplasty Surgery in Operating Rooms Complying with Current United States Ventilation Specifications. Am J Infect Control 2022:S0196-6553(22)00790-8. [DOI: 10.1016/j.ajic.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
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Jennings JM, Johnson RM, Brady AC, Stuckey WP, Pollet AK, Dennis DA. Effectiveness of Manual Terminal Cleaning Varies on High-Touch Surfaces Near the Operative Field. Arthroplast Today 2022; 17:53-57. [PMID: 36032796 PMCID: PMC9399380 DOI: 10.1016/j.artd.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/16/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Periprosthetic joint infection may result from pathogen to patient transmission within the environment. The purpose of this study is to evaluate the contamination level of selected high-touch surfaces in the operating room (OR) using a blacklight fluorescent marking system after a manual terminal clean. Methods Prior to the manual terminal clean, 16 high-touch surfaces were marked using a blacklight fluorescent gel. The marked areas were assessed the next morning for thoroughness of cleaning. Surfaces were categorized based on the average percent of the marks removed as “clean” (>75%), “partially clean” (26%-74%), or poorly cleaned (<25%). This process was repeated randomly 12 times. Terminal cleaning was done in the standard fashion, and the perioperative team was unaware of the initiation of this study. Results A total of 936 marks were analyzed. There was a significant difference in the number of marks completely clean (29.1%, 272/936) vs marks that were not touched (40.8%, 382/936), P < .001. Only the OR back table (75%) had a rating of clean. Partially clean areas included Mayfield table (72%), overhead lights (70.1%), infusion pump (61.1%), clock reset button (58.3%), table remote control (50%), tourniquet machine (50%), and the OR table (33.3%). Poorly cleaned surfaces included anesthesia medication cart (21.8%), door handles (20.8%), phone (16.7%), electrocautery unit (16.7%), foot pedal (16.7%), anesthesia cart (16.2%), nurses’ station (14.1%), and supply cabinet doors (6%). Conclusions Effectiveness of manual terminal cleaning varied greatly across surfaces. In general, surfaces further from the operative field were less likely to have markings removed.
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Affiliation(s)
- Jason M. Jennings
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Corresponding author. Colorado Joint Replacement, 2535 S. Downing St Suite 100, Denver, CO 80210, USA. Tel.: +1 720 524 1367.
| | | | | | | | | | - Douglas A. Dennis
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
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Thomas AM, Wilkinson MAC, Garvey MI. Changes in orthopaedic operating theatre practice, monitored using settle plates. Ann R Coll Surg Engl 2022; 104:600-604. [PMID: 35442847 PMCID: PMC9433170 DOI: 10.1308/rcsann.2021.0328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION The importance of ultraclean air in reducing deep infection was studied by Charnley who showed that the rate decreased as the airborne bacterial load was reduced. The effectiveness was shown in a large Medical Research Council (MRC) trial, but registry data have not shown a consistent benefit. Because we treat patients with rheumatoid arthritis, we decided to look at our theatre air quality. METHODS In phase 1 we monitored air quality using settle plates, exposed for one hour after the incision, on the instrument trolleys in a joint replacement theatre. In phase 1 the scrub person did not wear a body exhaust system. In phase 2 all three staff used a body exhaust system, and we played close attention to the orientation and position of the surgical lights and trolleys. RESULTS In phase 1 we grew 0.24 colonies/plate/hour in the ultraclean zone, which is comparable to the Charnley trial findings. In the second phase we grew 0.03 colonies/plate/hour (p<0.001). When plates were placed on the trolleys in controlled positions there was a tendency for the colonies to appear on the corners of the trolleys at the edge of the clean zone (NS). DISCUSSION The study showed that in phase 1 colony counts comparable to the original Charnley studies were achieved. Colony counts of 0.03 colonies/plate/hour can be achieved in contemporary practice, with all team members using body exhausts.
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Jennings JM, Miner TM, Johnson RM, Pollet AK, Brady AC, Dennis DA. A back table ultraviolet light decreases environmental contamination during operative cases. Am J Infect Control 2022; 50:686-689. [PMID: 34610393 DOI: 10.1016/j.ajic.2021.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The purpose of this study is to assess the impact of a germicidal ultraviolet light-emitting diode (LED) on the contamination level of a back table in the operating room (OR) during total joint arthroplasty procedures. METHODS Eight Tryptic Soy Agar petri plates were placed on a table located near the operative field and exposed to air. One plate was removed on the hour over an 8-hour time span. The back table had either an UV-LED for disinfection or a sham UV-LED. This process was repeated in 12 different ORs (6 with UV light, 6 with sham device). The plates were then incubated for 48 hours at 36°C ± 1°C . Colony forming units (CFU) were recorded 24 and 48 hours after incubation. RESULTS There was a statistically significant difference in total CFUs between the intervention vs sham at 24-hours (27 vs 95, P = .0001) and 48-hours (38 vs 122, P < .0001). The multivariate analysis revealed that the 24-hour and 48-hour count, the predictors UV light (P = .002) and hour of plate removal (P = .050) were statistically significantly associated with CFU counts. Together, the predictor variables explained 15.8% and 23.0% of the variance in CFU counts at 24- and 48-hours, respectively. CONCLUSIONS A back table UV-LED may decrease environmental contamination near the operative field. This has potential to lead to a decrease in joint infection.
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Houltz E. Is there evidence for bacteria-carrying particles causing postoperative surgical site infections? J Hosp Infect 2022; 122:214-216. [PMID: 35121069 DOI: 10.1016/j.jhin.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Erik Houltz
- Department of Anaesthesia and Intensive Care, Institute of Surgical Sciences, The Sahlgrenska Academy, Gothenburg University, 41345 Gothenburg, Sweden.
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Svetanoff WJ, Dekonenko C, Briggs KB, Sujka JA, Osuchukwu O, Dorman RM, Oyetunji TA, St Peter SD. Debunking the Myth: What You Really Need to Know about Clothing, Electronic Devices, and Surgical Site Infection. J Am Coll Surg 2021; 232:320-331.e7. [PMID: 33453379 DOI: 10.1016/j.jamcollsurg.2020.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Wendy Jo Svetanoff
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Charlene Dekonenko
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Kayla B Briggs
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Joseph A Sujka
- Department of General Surgery, Tampa General Hospital, Tampa, FL
| | - Obiyo Osuchukwu
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Robert M Dorman
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Tolulope A Oyetunji
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO; University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO
| | - Shawn D St Peter
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO; University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO.
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Wang Q, Xu C, Goswami K, Tan TL, Parvizi J. Association of Laminar Airflow During Primary Total Joint Arthroplasty With Periprosthetic Joint Infection. JAMA Netw Open 2020; 3:e2021194. [PMID: 33064136 PMCID: PMC7568200 DOI: 10.1001/jamanetworkopen.2020.21194] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Whether laminar airflow (LAF) in the operating room is effective for decreasing periprosthetic joint infection (PJI) after total joint arthroplasty remains a clinically important yet controversial issue. OBJECTIVE To investigate the association between operating room LAF ventilation systems and the risk of PJI in patients undergoing total joint arthroplasty. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted of 6972 consecutive patients undergoing primary total knee arthroplasty or total hip arthroplasty at 2 surgical facilities within a single institution from January 1, 2013, to September 15, 2017, with a minimum of 1 year of follow-up. All procedures were performed by 5 board-certified arthroplasty surgeons. Statistical analysis was performed from January 1, 2014, to September 15, 2018. EXPOSURE Patients underwent total joint arthroplasty in operating rooms equipped with either LAF or turbulent airflow. MAIN OUTCOMES AND MEASURES Patient characteristics were extracted from clinical records. Periprosthetic joint infection was defined according to Musculoskeletal Infection Society criteria within 1 year of the index arthroplasty. A multivariable logistic regression model was performed to explore the potential association between LAF and risk of PJI at 1 year, and then a sensitivity analysis using propensity score matching was performed to further validate the findings. RESULTS A total of 6972 patients (2797 who underwent total knee arthroplasty and 4175 who underwent total hip arthroplasty; 3690 women [52.9%]; mean [SD] age, 63.9 [10.7] years) were included. The incidence of PJI within 1 year for patients from the facility without LAF was similar to that of patients from the facility with LAF (0.4% [12 of 3027] vs 0.5% [21 of 3945]). In the multivariable logistic regression analysis, after all confounding factors were taken into account, the use of LAF was not associated with a reduction of the risk of PJI (adjusted odds ratio, 0.94; 95% CI, 0.40-2.19; P = .89). After propensity score matching, there was no significant difference in the incidence of PJI within 1 year for patients who underwent total joint arthroplasty at these 2 sites. CONCLUSIONS AND RELEVANCE This study suggests that the use of LAF in the operating room was not associated with a reduced incidence of PJI after primary total joint arthroplasty. With an appropriate perioperative protocol for infection prevention, LAF does not seem to play a protective role in PJI prevention.
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Affiliation(s)
- Qiaojie Wang
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Shanghai Sixth People’s Hospital, Shanghai, China
| | - Chi Xu
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Orthopaedic Surgery, General Hospital of People’s Liberation Army, Beijing, China
| | - Karan Goswami
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Timothy L. Tan
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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The Impact of Intraoperative Hypothermia on Blood Loss and Allogenic Blood Transfusion in Total Knee and Hip Arthroplasty: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1096743. [PMID: 32461961 PMCID: PMC7222593 DOI: 10.1155/2020/1096743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/21/2020] [Accepted: 04/27/2020] [Indexed: 02/01/2023]
Abstract
Background Total joint arthroplasty (TJA) usually leads to substantial blood loss, which may cause allogenic blood transfusion. Hypothermia occurring during operation has been reported to increase blood loss and transfusion rates in nonorthopedic cohorts. However, the relationship between intraoperative hypothermia and blood loss remains controversial in patients undergoing orthopedic surgeries. The aims of this study were to investigate the incidence of hypothermia and identify the impact of intraoperative body temperature and hypothermia on blood loss and transfusion rates in total knee and hip arthroplasty (TKA and THA, respectively). Methods This retrospective study enrolled 616 consecutive patients, who underwent primary unilateral TKA or THA at our institution during the period from April 2012 to July 2014. The occurrence of a temperature below 36°C during the operation was documented to identify the incidence of hypothermia. Univariate analysis was performed to find the risk factors for hypothermia. Multiple regression analysis and multivariate logistic regression analysis were employed to explore the association of intraoperative temperature and hypothermia with intraoperative blood loss and perioperative blood transfusion. Results The incidence of intraoperative hypothermia was 13.5%, 14.0%, and 13.1% in TJA, TKA, and THA, respectively. Intraoperative temperature (P = 0.045, P = 0.006) and hypothermia (P = 0.042, P < 0.001) were associated with intraoperative blood loss and perioperative transfusion in TKA. Intraoperative temperature (P = 0.002) was negatively related to the amount of blood loss, and hypothermia (P = 0.031) was the independent risk factor for transfusion in THA. Conclusion Intraoperative hypothermia is associated with increased blood loss and transfusion rates in TJA. Efforts should be made to maintain normothermia during operation in these patients.
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Goswami K, Stevenson KL, Parvizi J. Intraoperative and Postoperative Infection Prevention. J Arthroplasty 2020; 35:S2-S8. [PMID: 32046826 DOI: 10.1016/j.arth.2019.10.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 02/01/2023] Open
Abstract
Implementation of strategies for prevention of surgical site infection and periprosthetic joint infection is gaining further attention. We provide an overview of the pertinent evidence-based guidelines for infection prevention from the World Health Organization, the Centers for Disease Control and Prevention, and the second International Consensus Meeting on Musculoskeletal Infection. Future work is needed to ascertain clinical efficacy, optimal combinations, and the cost-effectiveness of certain measures.
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Affiliation(s)
- Karan Goswami
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | | | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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13
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Kümin M, Deery J, Turney S, Price C, Vinayakam P, Smith A, Filippa A, Wilkinson-Guy L, Moore F, O'Sullivan M, Dunbar M, Gaylard J, Newman J, Harper CM, Minney D, Parkin C, Mew L, Pearce O, Third K, Shirley H, Reed M, Jefferies L, Hewitt-Gray J, Scarborough C, Lambert D, Jones CI, Bremner S, Fatz D, Perry N, Costa M, Scarborough M. Reducing Implant Infection in Orthopaedics (RIIiO): Results of a pilot study comparing the influence of forced air and resistive fabric warming technologies on postoperative infections following orthopaedic implant surgery. J Hosp Infect 2019; 103:412-419. [PMID: 31493477 DOI: 10.1016/j.jhin.2019.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/28/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Active warming during surgery prevents perioperative hypothermia but the effectiveness and postoperative infection rates may differ between warming technologies. AIM To establish the recruitment and data management strategies needed for a full trial comparing postoperative infection rates associated with forced air warming (FAW) versus resistive fabric warming (RFW) in patients aged >65 years undergoing hemiarthroplasty following fractured neck of femur. METHODS Participants were randomized 1:1 in permuted blocks to FAW or RFW. Hypothermia was defined as a temperature of <36°C at the end of surgery. Primary outcomes were the number of participants recruited and the number with definitive deep surgical site infections. FINDINGS A total of 515 participants were randomized at six sites over a period of 18 months. Follow-up was completed for 70.1%. Thirty-seven participants were hypothermic (7.5% in the FAW group; 9.7% in the RFW group). The mean temperatures before anaesthesia and at the end of surgery were similar. For the primary clinical outcome, there were four deep surgical site infections in the FAW group and three in the RFW group. All participants who developed a postoperative infection had antibiotic prophylaxis, a cemented prosthesis, and were operated under laminar airflow; none was hypothermic. There were no serious adverse events related to warming. CONCLUSION Surgical site infections were identified in both groups. Progression from the pilot to the full trial is possible but will need to take account of the high attrition rate.
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Affiliation(s)
- M Kümin
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - J Deery
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - S Turney
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - C Price
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - P Vinayakam
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - A Smith
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - A Filippa
- Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - F Moore
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - M O'Sullivan
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - M Dunbar
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - J Gaylard
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - J Newman
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - C M Harper
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK
| | - D Minney
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK
| | - C Parkin
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK
| | - L Mew
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK
| | - O Pearce
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK
| | - K Third
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - H Shirley
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - M Reed
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - L Jefferies
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J Hewitt-Gray
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Scarborough
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Lambert
- Brighton and Sussex Medical School, Brighton, UK
| | - C I Jones
- Brighton and Sussex Medical School, Brighton, UK
| | - S Bremner
- Brighton and Sussex Medical School, Brighton, UK
| | - D Fatz
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - N Perry
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - M Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - M Scarborough
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Abstract
INTRODUCTION Surgical instrument contamination during total joint replacement is a matter of major concern. Available recommendations suggest changing suction tips, gloves and avoiding light handle manipulation during the procedure. There is a paucity of data regarding surgical gown contamination. The aim of the present study was to evaluate the contamination rate of surgical gowns (SGs) during total hip arthroplasty (THA) and secondarily compare it with other orthopedic procedures. MATERIALS AND METHODS One hundred and forty surgical gowns (from 70 surgeries) were screened for bacterial contamination using thioglycolate (a high-sensitivity culture broth). The THA contamination rate was compared with those of knee and spine procedures. Controls were obtained at the beginning of every surgery and from the culture broth. The procedure's duration and the level of training of the surgeon were evaluated as potential risk factors for contamination. RESULTS Bacterial contamination was identified on 12% of surgical gowns (22% of surgical procedures). The contamination rate during THA was 4.1% (2% in primary THA and 8.3% in revisions) vs 21.67% during other surgeries (spine and knee) (OR 6.15, p = 0.012). There were no contaminated SGs during THAs performed in ≤ 2 h (0/33 SGs) vs 7.5% (3/40) for THAs that took ≥ 2 h (p = 0.25). CONCLUSION There was a high rate of SG contamination during orthopedic procedures that was higher during non-arthroplasty procedures and prolonged THAs. There were no contaminated surgical gowns in THAs under 120 min, efforts should point keeping primary THAs under this cutoff time. As a general recommendation, SGs should be changed every time there is concern about potential contamination.
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