<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "https://jats.nlm.nih.gov/nlm-dtd/publishing/3.0/journalpublishing3.dtd">
<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="research-article" dtd-version="3.0" xml:lang="en">
<front>
<journal-meta>
<journal-id journal-id-type="publisher">JBJI</journal-id>
<journal-title-group>
<journal-title>Journal of Bone and Joint Infection</journal-title>
<abbrev-journal-title abbrev-type="publisher">JBJI</abbrev-journal-title>
<abbrev-journal-title abbrev-type="nlm-ta">J. Bone Joint Infect.</abbrev-journal-title>
</journal-title-group>
<issn pub-type="epub">2206-3552</issn>
<publisher><publisher-name>Ivyspring</publisher-name>
<publisher-loc>Göttingen, Germany</publisher-loc>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.7150/jbji.30613</article-id>
<title-group>
<article-title>Perioperative Contamination of Orthopaedic Polyethylene Implants, Targeting Devices and Arthroscopes. Experts&apos; Decision Tree and Literature Review</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Vautrin</surname>
<given-names>Matthias</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Moerenhout</surname>
<given-names>Kevin</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Udin</surname>
<given-names>Gilles</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Borens</surname>
<given-names>Olivier</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
</contrib-group><aff id="aff1">
<label>1</label>
<addr-line>Orthopaedic Trauma Surgery Unit, Department of the Locomotor Apparatus, Lausanne. University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.</addr-line>
</aff>
<pub-date pub-type="epub">
<day>16</day>
<month>02</month>
<year>2019</year>
</pub-date>
<volume>4</volume>
<issue>2</issue>
<fpage>65</fpage>
<lpage>71</lpage>
<permissions>
<copyright-statement>Copyright: &#x000a9; 2019 Matthias Vautrin et al.</copyright-statement>
<copyright-year>2019</copyright-year>
<license license-type="open-access">
<license-p>This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit <ext-link ext-link-type="uri"  xlink:href="https://creativecommons.org/licenses/by/4.0/">https://creativecommons.org/licenses/by/4.0/</ext-link></license-p>
</license>
</permissions>
<self-uri xlink:href="https://jbji.copernicus.org/articles/4/65/2019/jbji-4-65-2019.html">This article is available from https://jbji.copernicus.org/articles/4/65/2019/jbji-4-65-2019.html</self-uri>
<self-uri xlink:href="https://jbji.copernicus.org/articles/4/65/2019/jbji-4-65-2019.pdf">The full text article is available as a PDF file from https://jbji.copernicus.org/articles/4/65/2019/jbji-4-65-2019.pdf</self-uri>
<abstract>
<p>&lt;p class=&quot;p p-first&quot; id=&quot;__p2&quot;&gt;&lt;strong&gt;&lt;em&gt;Introduction&lt;/em&gt;&lt;/strong&gt; Sterility errors during orthopaedic procedures can be stressful for the surgeon or scrub nurse and lead to devastating infectious complications and liability issues. This paper aims to review orthopaedic surgeon practices and propose possible attitudes to adopt.&lt;/p&gt;&lt;p id=&quot;__p3&quot;&gt;&lt;strong&gt;&lt;em&gt;Methods&lt;/em&gt;&lt;/strong&gt; Out of 1023 questionnaires sent, 170 orthopaedic surgeons answered a Volunteer Feedback Template (multiple-choice test) by SurveyMonkey® (San Mateo, CA, USA) anonymously. The survey questioned surgeon&apos;s response to a sterility mistake during a standard total knee joint replacement, trauma surgery and arthroscopic procedure. Those “sterility mistake” situations occurred when there was contamination of 1) a sterile polyethylene (PE) 2) a sterile targeting device, and 3) an arthroscope.&lt;/p&gt;&lt;p id=&quot;__p4&quot;&gt;&lt;strong&gt;&lt;em&gt;Results&lt;/em&gt;&lt;/strong&gt; When the definitive PE is contaminated, and if a new definitive PE will only be available 2 hours later, 52% of surgeons would wait for the new definitive PE (p&amp;lt;0.001). In the same situation, if a new PE will only be available in 4 hours, the results showed a significant difference favoring two other options: ”putting a definitive PE one size smaller or bigger with balance adjustment” (31%); and “leaving the provisional PE in the joint, closing the wound and re-operating the patient in the coming days when the definitive PE arrives” (29%) (p&amp;lt;0.001). When the new PE is only available 24 hours later results were 34% and 31%, respectively (p&amp;lt;0.001). In the case of a surgical procedure for a classic intertrochanteric fracture, if the carbon fiber targeting device is contaminated, most surgeons (50%) chose to put the nail without the targeting device and finish the surgery (p&amp;lt;0.001). When the arthroscope is desterilized, 39% of participants would wait until the arthroscope has been sterilized again (approximately 2 hours), while 24% would use another procedure (p&amp;lt;0.001). Sixty-two percent of surgeons would adapt their strategy. No clear trend could be identified in terms of antibiotic treatment following a sterility error.&lt;/p&gt;&lt;p class=&quot;p p-last&quot; id=&quot;__p5&quot;&gt;&lt;strong&gt;&lt;em&gt;Conclusions&lt;/em&gt;&lt;/strong&gt; There are no established guidelines on how to deal with sterility breaches during surgery and on the antibiotic strategy following the prolonged surgical time resulting from the delay for a new implant. The most common course of action chosen by participating surgeons is detailed in our expert decision tree - if another sterile component is not available within 2 hours - : insertion of another PE size, rescheduling the operation, adapting the surgical technique (for trauma procedures), or soaking the arthroscope in disinfectant solution. As instances of contamination cannot be avoided, it is recommended to have a minimum of two copies of sterile PE implants, arthroscopes or targeting devices readily available before surgery begins-.&lt;/p&gt;</p>
</abstract>
<counts><page-count count="7"/></counts>
</article-meta>
</front>
<body/>
<back>
<ref-list>
<title>References</title>
<ref id="ref0">
<label>0</label><mixed-citation publication-type="other" xlink:type="simple">Ribeiro M, Monteiro FJ, Ferraz MP. Infection of orthopedic implants with emphasis on bacterial adhesion process and techniques used in studying bacterial-material interactions. Biomatter. 2012 Oct 1;2(4):176–194. [PMC free article]</mixed-citation>
</ref>
<ref id="ref1">
<label>1</label><mixed-citation publication-type="other" xlink:type="simple">Burns KE, Duffett M, Kho ME. et al. A guide for the design and conduct of self-administered surveys of clinicians. CMAJ. 2008;179(3):245–52. [PMC free article]</mixed-citation>
</ref>
<ref id="ref2">
<label>2</label><mixed-citation publication-type="other" xlink:type="simple">Morgenstern M, Moriarty TF, Kuehl R, International survey among orthopaedic trauma surgeons: Lack of a definition of fracture-related infection Injury. 2018; Feb 6. pii: S0020-1383(18)30058-5.  [PubMed]</mixed-citation>
</ref>
<ref id="ref3">
<label>3</label><mixed-citation publication-type="other" xlink:type="simple">Cheng H, Chen BP, Soleas IM. et al. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt) 2017 Aug 1;18(6):722–735. [PMC free article]</mixed-citation>
</ref>
<ref id="ref4">
<label>4</label><mixed-citation publication-type="other" xlink:type="simple">Balato G, Di Donato SL, Ascione T. et al. Knee Septic Arthritis after Arthroscopy: Incidence, Risk Factors, Functional Outcome, and Infection Eradication Rate. Joints. 2017;5(2):107–113. [PMC free article]</mixed-citation>
</ref>
<ref id="ref5">
<label>5</label><mixed-citation publication-type="other" xlink:type="simple">Prokuski L, Clyburn TA Evans RP. et al. Prophylactic antibiotics in orthopaedic surgery. Instr Course Lect. 2011;60:545–55.</mixed-citation>
</ref>
<ref id="ref6">
<label>6</label><mixed-citation publication-type="other" xlink:type="simple">van Kasteren ME, Manniën J, Ott A. et al. (2007). Antibiotic Prophylaxis and the Risk of Surgical Site Infections following Total Hip Arthroplasty: Timely Administration Is the Most Important Factor. Clin Infect Dis. 2007 Apr 1;44(7):921–7.</mixed-citation>
</ref>
<ref id="ref7">
<label>7</label><mixed-citation publication-type="other" xlink:type="simple">Ruder JA, Springer BD. Treatment of Periprosthetic Joint Infection Using Antimicrobials: Dilute Povidone-Iodine Lavage. J Bone Jt Infect. 2017 Jan 1;2(1):10–14. [PMC free article]</mixed-citation>
</ref>
<ref id="ref8">
<label>8</label><mixed-citation publication-type="other" xlink:type="simple">Knobben BA, Engelsma Y, Neut D. et al. Intraoperative contamination influences wound discharge and periprosthetic infection. Clin Orthop Relat Res. 2006 Nov;452:236–41.</mixed-citation>
</ref>
<ref id="ref9">
<label>9</label><mixed-citation publication-type="other" xlink:type="simple">Parvizi J, Barnes S, Shohat N, Edmiston CE Jr. Environment of care: Is it time to reassess microbial contamination of the operating room air as a risk factor for surgical site infection in total joint arthroplasty? Am J Infect Control. 2017 Nov 1;45(11):1267–1272.</mixed-citation>
</ref>
<ref id="ref10">
<label>10</label><mixed-citation publication-type="other" xlink:type="simple">Ward WG Sr, Cooper JM, Lippert D. et al. Glove and gown effects on intraoperative bacterial contamination. Ann Surg. 2014 Mar;259(3):591–7.</mixed-citation>
</ref>
<ref id="ref11">
<label>11</label><mixed-citation publication-type="other" xlink:type="simple">Bible JE, O&apos;Neill KR, Crosby CG. et al. Implant contamination during spine surgery. Spine J. 2013 Jun;13(6):637–40.</mixed-citation>
</ref>
<ref id="ref12">
<label>12</label><mixed-citation publication-type="other" xlink:type="simple">Whyte W, Hodgson R, Tinkler J. The importance of airborne bacterial contamination of wounds. J Hosp Infect. 1982 Jun;3(2):123–35.</mixed-citation>
</ref>
<ref id="ref13">
<label>13</label><mixed-citation publication-type="other" xlink:type="simple">Muilwijk J, van den Hof S, Wille JC. Associations between surgical site infection risk and hospital operation volume and surgeon operation volume among hospitals in the Dutch nosocomial infection surveillance network. Infect Control Hosp Epidemiol. 2007 May;28(5):557–63.</mixed-citation>
</ref>
<ref id="ref14">
<label>14</label><mixed-citation publication-type="other" xlink:type="simple">Guerado E, Cano JR, Cruz E. et al. Should hip fractures be operated upon only by specialist hip unit surgeons in order to lower rates of surgical site infection? Inter Orthop. 2015;39(1):105–110.</mixed-citation>
</ref>
<ref id="ref15">
<label>15</label><mixed-citation publication-type="other" xlink:type="simple">Lüdemann M, Munoz P, Wagner M. et al. The Effect of Antiseptics in the Prophylaxis of Infection in Orthopaedic Surgery. Z Orthop Unfall. 2018 Oct;156(5):567–573.</mixed-citation>
</ref>
<ref id="ref16">
<label>16</label><mixed-citation publication-type="other" xlink:type="simple">Khan SA, Kumar A, Varshney MK. et al. Accidentally falling instruments during orthopaedic surgery: time to wake up! ANZ J Surg. 2008;78(9):794–5.</mixed-citation>
</ref>
<ref id="ref17">
<label>17</label><mixed-citation publication-type="other" xlink:type="simple">Willis-Owen CA, Konyves A, Martin DK. Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. J Bone Joint Surg Br. 2010 Aug;92(8):1128–33.</mixed-citation>
</ref>
</ref-list>
</back>
</article>