Speaker: Surgeons should be mindful of contaminated gloves during infected, revision TJA
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Surgical gloves are a common source of contamination in revision total joint arthroplasty cases; therefore, surgeons should consider intraoperative glove changes and thorough irrigation, according to a speaker.
“[Periprosthetic joint infection (PJI)] has been associated with increased morbidity [and] mortality, as well as increased hospital costs,” Leanne Ludwick, BS, said in her presentation at the Musculoskeletal Infection Society Annual Meeting. “No precise protocol has been written to direct surgeons on when to change their gloves, whether that be after a certain amount of time in the case or at specific stages in the case,” she added.
In a prospective study performed at Rothman Orthopaedic Institute, Ludwick and colleagues analyzed PJI rates, and culture swab and next-generation sequencing (NGS) results of 25 infected, revision TJA cases and 10 primary TJA cases. In the revision TJA cases, researchers collected gloves at 20-minute intervals for testing. The negative control testing in the primary TJA cases consisted of culture swabs of chamber cuts and sterile instruments on the back table, Ludwick said.
All cultures were negative in the primary TJA cases, and three out of 37 samples were found to be NGS positive for bacteria that were considered as a contaminant. In the revision TJA cases, 48.4% of samples tested positive for microbial organisms, such as Staphylococcus aureus, Staphylococcus epidermidis and Enterococcus faecalis.
“As a result, surgeons may want to consider performing a thorough irrigation of the joint and changing gloves immediately following arthrotomy in infected cases,” Ludwick said.
“Future directions of this study will look to collect gloves before and immediately following arthrotomy to further isolate the role the opening of the joint may play in cross contamination,” she added. “Additionally, we may also consider looking to provide more data to evaluate the use of two surgical setups when caring for infected cases.”
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Chisari E, et al. Paper #799. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 6-7, 2021; Fort Lauderdale, Florida (hybrid meeting).
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