Implant contamination as a cause of surgical site infection in spinal surgery: are single-use implants a reasonable solu
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(2020) 21:634
RESEARCH ARTICLE
Open Access
Implant contamination as a cause of surgical site infection in spinal surgery: are single-use implants a reasonable solution? – a systematic review Friederike Schömig* , Carsten Perka, Matthias Pumberger and Rudolf Ascherl
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. Keywords: Implant contamination, Sterilization, Single-use implants, Spinal surgery, Bacteria
Background In the past few years, the number of spine surgeries performed worldwide has been steadily increasing [1, 2]. One of the main perioperative complications in orthopaedic surgery is surgical site infection (SSI). In spinal surgery, surgical site infection occurs in 2 to 13% and is * Correspondence: [email protected] Center for Musculoskeletal Surgery, Charité – University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
associated with an increase in patient morbidity, revision surgery, extended hospitalization and health care costs [3, 4]. Factors associated with SSI are the procedures performed, surgical environment and technique, reprocessing procedures of implants and instruments, postoperative measures, and the patients’ immunity. Most of these factors rely on asepsis rather than increasing or decreasing a patient’s immunity [5].
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