Abstract
Aim
The majority of peri-prosthetic joint infection occurring within 1 year of surgery is due to introduction of microbes at the time of surgery. Lavage of total knee replacement leaves a pool of fluid on the surgical drapes. This fluid could be a direct source of wound contamination via suction catheter tip, gloves or instruments.
Method
Twenty patients undergoing total knee arthroplasty had a sample of drape fluid sent, after prosthesis implantation, for standard and enrichment culture. The surgery took place in a laminar low theatre with scrub teams in togas* and drapes**. Normal saline was used as the wash. 20ml fluid was taken via syringe and transferred to blood culture bottles in theatre post-operatively.
Results
Ten samples (50%) showed bacterial contamination; of these 55% were one organism and 45% polymicrobial. Coagulase negative staphylococcus (CNS) occurred in 90% of positive samples, followed by Moraxella (20%) and MSSA (10%). Organisms grown included skin, nasal, respiratory and environmental pathogens, all but one previously documented as causing septic arthritis.
Conclusions
The major contaminant found in our study, CNS, is a skin commensal. This could be from increasing resistance to skin preparations or a decline in theatre etiquette. Fluid collecting in the drapes is a source of potential contamination. All aspects of infection control protocol need continual re-assessment including drape quality, skin and patient preparation and theatre etiquette. Surgeons cannot assume that routine skin preparation and peri-operative antibiotics will eradicate bacterial contamination. It is all our responsibility to implement best infection control practice both in the operating room and through entire patient journey.
Stryker, AMMI level IV
Sangewold (EN 13795)
