Otis C Shirley1, Ali Bayan2, Mark Zhu2, James P Dalton3, Siouxsie Wiles3, Simon W Young4. 1. Orthopaedic Department, Northshore Hospital, 124 Shakespeare Road, Westlake 0622, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand. Otis.C.Shirley@gmail.com. 2. Orthopaedic Department, Northshore Hospital, 124 Shakespeare Road, Westlake 0622, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand. 3. Bioluminescent Superbugs Lab, Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, 502-301K, 85 Park Rd, Grafton/Private Bag 92019, Auckland, 1142, New Zealand. 4. Department of Orthopaedic Surgery, North Shore Hospital, University of Auckland, 124 Shakespeare Road, Takapuna Private Bag 93-503, Auckland, 0740, New Zealand.
Abstract
BACKGROUND: Deep infection following arthroplasty remains a devastating complication. Some registry data suggests that modern positive-pressure surgical helmet systems (SHS) are associated with a paradoxical increase in infection rates, and as such their role in arthroplasty remains unclear. The aim of this study was to investigate whether SHS increase wound contamination in total knee arthroplasty (TKA) and if this contamination can be reduced by placing tape around the gown/glove interface. METHODS:Seventy-five patients were randomised into three groups: scrubbed theatre staff wore standard surgical gowns (SG), SHS without tape at the gown/glove interface, or SHS with tape. All TKA operations were carried out by the same surgeon. Wound contamination was assessed using a wound culture technique. Blinded laboratory analysis was performed. RESULTS: There were 5/50 culture positive cases when a SHS was used compared to 0/25 when a SG was used; but this difference was not statistically significant (p = 0.16). There were 4/24 culture positive cases when SHS with tape was used compared to 1/26 when SHS without tape was used; but this difference was not statistical significant p = 0.18. CONCLUSION: We found no difference in wound contamination between SG and SHS. Addition of tape at the gown/glove interface did not alter the contamination rate. The choice of surgical gown should take into account cost, comfort and personal protection; as this study found no evidence that wound contamination rates will be altered.
RCT Entities:
BACKGROUND:Deep infection following arthroplasty remains a devastating complication. Some registry data suggests that modern positive-pressure surgical helmet systems (SHS) are associated with a paradoxical increase in infection rates, and as such their role in arthroplasty remains unclear. The aim of this study was to investigate whether SHS increase wound contamination in total knee arthroplasty (TKA) and if this contamination can be reduced by placing tape around the gown/glove interface. METHODS: Seventy-five patients were randomised into three groups: scrubbed theatre staff wore standard surgical gowns (SG), SHS without tape at the gown/glove interface, or SHS with tape. All TKA operations were carried out by the same surgeon. Wound contamination was assessed using a wound culture technique. Blinded laboratory analysis was performed. RESULTS: There were 5/50 culture positive cases when a SHS was used compared to 0/25 when a SG was used; but this difference was not statistically significant (p = 0.16). There were 4/24 culture positive cases when SHS with tape was used compared to 1/26 when SHS without tape was used; but this difference was not statistical significant p = 0.18. CONCLUSION: We found no difference in wound contamination between SG and SHS. Addition of tape at the gown/glove interface did not alter the contamination rate. The choice of surgical gown should take into account cost, comfort and personal protection; as this study found no evidence that wound contamination rates will be altered.
Authors: M M Ploeger; C Jacobs; M Gathen; E Kaup; T M Randau; M J Friedrich; G T Hischebeth; M D Wimmer Journal: Arch Orthop Trauma Surg Date: 2018-06-11 Impact factor: 3.067