Suction during orthopaedic surgery. How safe is the suction tip?

The use of a suction system is mandatory in most orthopaedic procedures. In the unlikely event of contamination of the system, deep wound infection could occur, jeopardising the operation. We have prospectively studied 50 patients who underwent elective and orthopaedic trauma procedures during which a suction system was used. At the end of each procedure the suction catheter tip was sent for culture and microbiology. The suction tips showed bacterial contamination in 27 cases (54%). Staphylococcus species were responsible in 21 cases (77.8%). The tip was contaminated in only 1/11 procedures lasting less than one hour (9.1%), as compared with 26/39 procedures when operative time exceeded one hour (66.7%). However, deep wound infection was recorded in only one case. We believe that despite the low risk of deep wound infection, changing the suction tip every hour in long orthopaedic procedures or using the on/off switch is well justified in an effort to minimise the chances of deep wound infection.