Background

One of the important factors for surgical site infection prevention is the implementation of an ultraclean operating room. This study was designed to evaluate back-table sterility during total joint arthroplasty.

Methods

This prospective study includes 52 patients undergoing primary total joint arthroplasty between November 2021 and January 2022. A total of 4 swabs (2 air swabs and 2 table swabs) were obtained for each case, at the conclusion of surgery and prior to the takedown of drapes. One swab from each set was sent for culture, and the other was sent for next-generation sequencing (NGS) analysis.

Results

Among 104 back-table swabs, a total of 13 (12.5%) organisms were isolated. Of these, 7 organisms were isolated by culture and 6 by NGS. No microorganisms were isolated by both culture and NGS from back-table swabs. Among 104 air swabs, a total of 11 (10.6%) organisms were isolated. Of these, 6 microorganisms were isolated by culture and 5 by NGS. In 4 of the 104 swabs, both culture- and NGS-isolated organisms were from air swabs. Of the 104 (12.5%) back-table and air swabs, 13 were culture positive. While more than 1 pathogen was identified in 2 air swabs, all back-table swabs were monomicrobial by culture. Pathogens were identified from 11 of 104 (10.6%) swabs by NGS, while more than 1 pathogen was identified in 4 swabs (2 air and 2 back table).

Conclusion

The findings of this study raise an important issue that the surgical field including the sterile table setup for instruments is not “sterile” and can harbor pathogens.

中文翻译：

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手术室的无菌设置台没有那么无菌

背景

手术部位感染预防的重要因素之一是超洁净手术室的实施。本研究旨在评估全关节置换术期间的背台无菌性。

方法

这项前瞻性研究包括 52 名在 2021 年 11 月至 2022 年 1 月期间接受初次全关节置换术的患者。在手术结束时和取下手术单之前，每个病例总共获得了 4 个拭子（2 个空气拭子和 2 个桌拭子） . 每组中的一个拭子被送去培养，另一个被送去进行下一代测序 (NGS) 分析。

结果

在 104 个背台拭子中，总共分离出 13 个（12.5%）生物体。其中，7 种生物通过培养分离，6 种通过 NGS 分离。通过培养和 NGS 均未从后台拭子中分离出任何微生物。在 104 个空气拭子中，总共分离出 11 个（10.6%）生物体。其中，6 种微生物通过培养分离，5 种通过 NGS 分离。在 104 个拭子中的 4 个中，培养和 NGS 分离的生物都来自空气拭子。在 104 个 (12.5%) 背台和空气拭子中，13 个培养呈阳性。虽然在 2 个空气拭子中鉴定出超过 1 种病原体，但所有后台拭子培养均为单一微生物。通过 NGS 从 104 个拭子中的 11 个（10.6%）中鉴定出病原体，而在 4 个拭子（2 个空气和 2 个背板）中鉴定出超过 1 种病原体。

结论

这项研究的结果提出了一个重要问题，即手术区域（包括器械的无菌台设置）不是“无菌的”并且可能藏有病原体。