Abstract
Aim
”There is not a lot of data of the frequency and impact of unwanted events including glove perforation, contamination of the surgical field (drape perforation, laceration, detachment, bone bounced back from an unsterile object), unsterile object in the surgical field (hair, sweat droplet…), defecation, elevated air temperature, and others. Mishaps occur in every surgical theatre. These events should influence the surgical site infection rate but it is not clear to what extent. We wanted to calculate the frequency and measure the impact of these events on the infection and revision rate of the relative patients.”
Method
”In our institution, scrub nurses prospectively record untoward events in the theatres. Surgeons register complications before discharge. Stratified failures are recorded since 2002 within a registry. We analysed the respective databases and compared the revision and infection rate in the group with untoward effects with the outcome of all arthroplasty patients within the same time period. Two tailed Z statistical test was used for analysis.”
Results
“: Between 1.1.2012 and 31.12.2015 we operated 8130 prosthetic joints: 3994 THR and 3238 TKR including respectively 610 and 288 revisions. During this period we recorded 234 events (2.9 %) including 13 (0.16 %) defecations, 19 (0.2 %) contaminations with hair, 48 (0.6%) draping, gown or field sterility violations, 34 (0,4 %) glove perforations, 19 (0.5 %) occasions with elevated air temperature. In 37 (0,45%) surgeries there was a guest in the theatre. There were 8 (2.8%) infections and 10 (3.5%) revisions in the group with untoward events. The infection rate for all TJR was 0.64% the revision rate for any reason was 2.37%. For all the THR patient of the same study period was 2.1% for any reason and 0.7% for PJI and for the TKR 2.72 and 0.56 respectively. The difference is significant at p>0.05 for infection but not significant for revision for any reason.”
Conclusions
”In our series, the potentially serious sterility disruptive events in the operative rooms did result in increased infection rate among the involved patients but not an increase in revision rate. There is no data about the rate and the impact of these events besides for perforated surgical gloves with higher reported incidences than in our study influencing infection rate if perioperative antibiotic prophylaxis was not used. Ours is thus the first study to report some numbers about these events.”
