General Assembly, Prevention, Operating Room - Surgical Field: Proceedings of International Consensus on Orthopedic Infections
Abstract
Recommendation1: Instrument trays should be opened as close to the time of surgery as possible. Once opened, trays and instruments should be covered with a sterile towel or drape when not in use.
Recommendation2: Unknown. We recommend against the use of fluid-filled splash basins that sit open during surgery, based upon microbiological contamination data.
However, the independent association between splash basin contaminations and developments of subsequent SSIs/PJIs remains unclear. Recommendation3: While it is clear that electrocautery tips may become contaminated during surgery, no study has been able to prove a relationship between the amount of time that an electrocautery tip is exposed and its contamination.
However, in cases where there is known infection, such as a 1-stage or 2-stage exchange arthroplasty for PJI, we do recommend changing the electrocautery tip at the end of the "dirty" portion of the procedure and prior to reimplantation of components. Recommendation4: Yes.
The suction tips should be regularly changed during surgery. Although no time threshold has been established for its exchange, we believe it should be changed every 60 minutes.
Studies have shown that suction tips get contaminated during surgery and the contamination rate is higher with prolonged operative tim. Recommendation5: Suction tips can be introduced into the intramedullary canal during orthopedic surgery to remove fluid as needed, but should not be left in the canal where they draw in large volumes of ambient air and particles, that could potentially contaminate the intramedullary canal.