Table 2.
Included studies on preoperative sources of implant contamination
| Study | Source of contamination | Study size | Main results | Conclusion |
|---|---|---|---|---|
| Preoperative sources of implant contamination | ||||
| Agarwal et al. (2019a) [7] | Pedicle screws |
1. 6 pedicle screws 2. 1 implant tray with 164 pedicel screws |
1. 3 types of contaminants: corrosion, saccharide of unknown origin, soap residue 2. observed reprocessing time was < 2 h |
Repeatedly reprocessed pedicle screws may be source of SSI |
| Pinto et al. (2010) [8] | Surgical implants | 227 samples (76 from clean surgeries, 76 from contaminated surgeries, 75 from infected surgeries) | 47% microbial contamination of implants in clean surgeries, 70% in contaminated, and 80% in infected surgeries | Most of the microorganisms recovered are covered by the cleaning and sterilization process; antibiotic prophylaxis is important in clean surgeries |
| Lopes et al. (2019) [9] | FMRs and DGs | 9 FMRs and 9 DGs (3 rinsing, 3 manual cleaning, 3 manual plus automated cleaning) | 100% ATP contamination in rinsed only with 2–2.5 log10 fold reduction after manual or manual plus automated cleaning; soil present in all groups | Reusable surgical instruments show residual biological soil after reprocessing, which may have an adverse effect on patient outcome |
| Costa et al. (2018) [10] | FMRs, DGs, and single-use screws in clinical use for > 1 year | 73 FMRs (16 ATP, 8 CFU, 40 visual, 9 SEM), 19 DGs (8 ATP, 8 visual, 3 SEM), 123 screws (24 CFU, 90 visual, 9 SEM) |
1. FMRs: 75% showed ATP, 85% visible soil, 63% protein after cleaning 2. DGs: 38% showed ATP, 100% soil after cleaning 3. Screws: Biofilm and soil were visible after cleaning |
Ineffectiveness of manual reprocessing and reprocessing practices threatens patient safety |
| Smith et al. (2018) [11] | Surgical drills | 15 cannulated drill bits (3 per group) | 2 negative controls showed contaminant bacteria; 1 experimental drill showed inoculation bacteria | Standard autoclave sterilization may be inefficient and delay of reprocessing may increase the risk of resistant contamination |
| Mayer et al. (2016) [12] | Femoral BHs | 2 femoral BHs | Complete eradication at all target locations | Adequate decontamination of BHs can be achieved after steam sterilization |
| Bundgaard et al. (2019) [13] | Scissors, knife shafts, puncture cannulae | Not clear | All sterilized instruments showed protein residues below the accepted threshold regardless of holding time | No association between residual protein and holding time |
| Mont et al. (2013) [14] | Saws, cutting guides, trays | 202 patients treated with conventional instruments, 205 patients treated with single-use instruments | Single-use instrumentation led to a significant reduction of compromised pans from 7 to 1%; decrease in contamination in 57% | Single-use instruments will play an increasing role in orthopaedic surgery |
BH broach handle, CFU colony forming unit, DG depth gauge, FMR flexible medullary reamer, SEM scanning electron microscopy