O2283 IS THERE A RATIONALE FOR USING A SKIN KNIFE?

Abstract

Aims: The aim of this study was to reassess whether the use of a Ôone knife techniqueñ can be considered as safe as the current practice of using separate skin and inside knives for elective orthopaedic surgery. Methods: A tatal of 609 knife blades from 203 elective orthopaedic operations consisting of equal numbers of skin, inside and control blades, were cultured using direct and enrichment media. Results: Thirty-one skin blades (15.3%), 22 inside blades (10.8%) and 13 control blades (6.4%) gave bacterial growth. In only 3 cases (1.4%) skin and inside knife cultures grew corresponding organisms. However, in the presence of skin knife contamination the same organism was found on 10% of inside blades. It remains to be seen whether in the remaining 90% contamination of deeper layers was prevented by changing the knife after the skin incision, since the incidence of late deep sepsis is not yet known in these cases. Conclusions: The organisms cultured in this study were predominantly coagulase-negative staphylococci, known to be major culprits in early and late peripros-thetic infection. Our study suggests that the rationale for separate skin and inside knives can be supported, since the cost of a single deep infection in human and þnancial terms can be considerable