Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-04-2019 | Orthopaedic Surgery

Prevalence and quantification of contamination of knitted cotton outer gloves during hip and knee arthroplasty surgery

Authors: Thorsten Wichmann, T. Fintan Moriarty, Iris Keller, Stefan Pfister, Vanessa Deggim-Messmer, Emanuel Gautier, Fabian Kalberer, Peter P. Koch, Peter Wahl

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 4/2019

Abstract

Introduction

Knitted cotton outer gloves offer protection against surgical glove perforation and provide improved grip on instruments. These gloves absorb blood and other fluids during surgery, and may therefore also accumulate contaminating bacteria. To date, there is no published data on microbial contamination of such gloves during surgery.

Methods

Knitted cotton outer gloves used in primary and revision hip and knee arthroplasty from two Swiss hospitals were analysed by quantitative bacteriology. Samples were subjected to sonication and vortexing, followed by membrane filtration of the sonicate. Membranes were incubated under aerobic and anaerobic culture conditions, respectively, for 21 days. Total microbial load for each pair of gloves was determined by colony-forming units (CFU) count. Strain identification was performed with MALDI-TOF.

Results

A total of 43 pairs of gloves were collected from continuous series of surgeries. Under aerobic culture conditions, total CFU counts ranged 0–1103, 25 (58%) samples remaining sterile, and 4 (9%) yielding > 100 CFU. Under anaerobic culture conditions, total CFU counts ranged 0–3579, 22 (51%) samples remaining sterile, 6 (14%) yielding > 100 CFU. The only covariate significantly associated with the level of contamination was the provider hospital (p < 0.0001 for aerobic and p = 0.007 for anaerobic cultures). Strain identification revealed only skin commensals, mainly coagulase-negative staphylococci and Propionibacterium spp.

Conclusion

While contamination of surgical latex gloves is a well-known issue, no study has examined so far contamination of knitted cotton outer gloves. No or very low microbial contamination could be identified in the majority of the knitted cotton outer gloves assayed. However, a relevant proportion showed contamination far higher than estimated minimal thresholds for implant-associated infection. Clinical relevance of these findings remains to be established.

Louis SS et al (1998) Outer gloves in orthopaedic procedures: a polyester/stainless steel wire weave glove liner compared with latex. J Orthop Trauma 12(2):101–105CrossRefPubMed

Tanner J, Wraighte P, Howard P (2006) Knitted outer gloves in primary hip and knee arthroplasty. Hip Int 16(1):62–65CrossRefPubMed

Mischke C et al (2014) Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database Syst Rev 2014(3):CD009573

Gristina AG (1987) Biomaterial-centered infection: microbial adhesion versus tissue integration. Science 237(4822):1588–1595CrossRefPubMed

Bajpai V et al (2011) Quantification of bacterial adherence on different textile fabrics. Int Biodeterior Biodegradation 65(8):1169–1174CrossRef

Elek SD, Conen PE (1957) The virulence of Staphylococcus pyogenes for man; a study of the problems of wound infection. Br J Exp Pathol 38(6):573–586PubMedPubMedCentral

Zimmerli W et al (1982) Pathogenesis of foreign body infection: description and characteristics of an animal model. J Infect Dis 146(4):487–497CrossRefPubMed

Zimmerli W, Zak O, Vosbeck K (1985) Experimental hematogenous infection of subcutaneously implanted foreign bodies. Scand J Infect Dis 17(3):303–310CrossRefPubMed

Font-Vizcarra L et al (2011) Relationship between intraoperative cultures during hip arthroplasty, obesity, and the risk of early prosthetic joint infection: a prospective study of 428 patients. Int J Artif Organs 34(9):870–875CrossRefPubMed

10.

Tande AJ et al, Presentation C (2016) Risk factors, and outcomes of hematogenous prosthetic joint infection in patients with Staphylococcus aureus bacteremia. Am J Med 129(2):221 e11–e20CrossRef

11.

Bukhari SS, Harrison RA, Sanderson PJ (1993) Contamination of surgeons’ glove fingertips during surgical operations. J Hosp Infect 24(2):117–121CrossRefPubMed

12.

Al-Maiyah M et al (2005) Glove perforation and contamination in primary total hip arthroplasty. J Bone Joint Surg Br 87(4):556–559CrossRefPubMed

13.

Dawson-Bowling S et al (2011) Should outer surgical gloves be changed intraoperatively before orthopaedic prosthesis implantation? J Hosp Infect 78(2):156–157CrossRefPubMed

14.

Beldame J et al (2012) Surgical glove bacterial contamination and perforation during total hip arthroplasty implantation: when gloves should be changed. Orthop Traumatol Surg Res 98(4):432–440CrossRefPubMed

15.

Lakomkin N et al (2018) Glove Perforation in Orthopaedics: probability of tearing gloves during high-risk events in trauma surgery. J Orthop Trauma 32(9):474–479CrossRefPubMed

16.

Schwotzer N et al (2014) Optimal culture incubation time in orthopedic device-associated infections: a retrospective analysis of prolonged 14-day incubation. J Clin Microbiol 52(1):61–66CrossRefPubMedPubMedCentral

17.

Schafer P et al (2008) Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis 47(11):1403–1409CrossRefPubMed

18.

Butler-Wu SM et al (2011) Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection. J Clin Microbiol 49(7):2490–2495CrossRefPubMedPubMedCentral

19.

Bossard DA et al (2016) Optimal length of cultivation time for isolation of propionibacterium acnes in suspected bone and joint infections is more than 7 days. J Clin Microbiol 54(12):3043–3049CrossRefPubMedPubMedCentral

20.

Trampuz A et al (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357(7):654–663CrossRefPubMed

21.

Portillo ME et al (2014) Advantages of sonication fluid culture for the diagnosis of prosthetic joint infection. J Infect 69(1):35–41CrossRefPubMed

22.

Kaya I et al (2012) Glove perforation time and frequency in total hip arthroplasty procedures. Acta Orthop Traumatol Turc 46(1):57–60CrossRefPubMed

23.

Monsen T et al (2009) In vitro effect of ultrasound on bacteria and suggested protocol for sonication and diagnosis of prosthetic infections. J Clin Microbiol 47(8):2496–2501CrossRefPubMedPubMedCentral

24.

Dastgheyb S et al (2015) Effect of biofilms on recalcitrance of staphylococcal joint infection to antibiotic treatment. J Infect Dis 211(4):641–650CrossRefPubMed

25.

Davis N et al (1999) Intraoperative bacterial contamination in operations for joint replacement. J Bone Joint Surg Br 81(5):886–889CrossRefPubMed

26.

Rowlinson MC et al (2006) Isolation of a strictly anaerobic strain of Staphylococcus epidermidis. J Clin Microbiol 44(3):857–860CrossRefPubMedPubMedCentral

27.

Sampedro MF et al (2009) Species of Propionibacterium and Propionibacterium acnes phylotypes associated with orthopedic implants. Diagn Microbiol Infect Dis 64(2):138–145CrossRefPubMed

28.

Taber HW et al (1987) Bacterial uptake of aminoglycoside antibiotics. Microbiol Rev 51(4):439–457PubMedPubMedCentral

29.

Brandt C et al (2008) Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg 248(5):695–700CrossRefPubMed

30.

Tayton ER et al (2016) The impact of patient and surgical factors on the rate of infection after primary total knee arthroplasty: an analysis of 64,566 joints from the New Zealand Joint Registry. Bone Joint J 98-B(3):334–340CrossRefPubMed

31.

Pulido L et al (2008) Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 466(7):1710–1715CrossRefPubMedPubMedCentral

32.

Kahar Bador M et al (2015) Evaluation of the efficacy of antibacterial medical gloves in the ICU setting. J Hosp Infect 90(3):248–252CrossRefPubMed

Title: Prevalence and quantification of contamination of knitted cotton outer gloves during hip and knee arthroplasty surgery
Authors: Thorsten Wichmann
T. Fintan Moriarty
Iris Keller
Stefan Pfister
Vanessa Deggim-Messmer
Emanuel Gautier
Fabian Kalberer
Peter P. Koch
Peter Wahl
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 4/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-3061-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prevalence and quantification of contamination of knitted cotton outer gloves during hip and knee arthroplasty surgery

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2019

The outcomes of total knee arthroplasty in morbidly obese patients: a systematic review of the literature

Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line

Comparison of efficacy of shock-wave therapy versus corticosteroids in plantar fasciitis: a meta-analysis of randomized controlled trials

Patient-reported quality of life and pain after permissive weight bearing in surgically treated trauma patients with tibial plateau fractures: a retrospective cohort study

Surgical excision and not chemotherapy is the most powerful modality in treating synovial sarcoma: the UK’s North East experience

Evaluating risk factors following surgery for periprosthetic fractures around hip and knee arthroplasties