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CC BY-NC-ND 4.0 · J Lab Physicians 2022; 14(03): 284-289
DOI: 10.1055/s-0042-1742422
Original Article

Intraoperative Surgical Wound Contamination May Not Lead to Surgical-Site Infection in Patients Undergoing Clean Orthopaedic Procedures

John Ashutosh Santoshi
1   Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Prateek Behera
1   Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Ayush Gupta
2   Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Archa Sharma
2   Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Virendra Kumar Verma
1   Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Udit Agrawal
1   Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Shashank Purwar
2   Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Abstract

Objectives Surgical-site infections (SSIs) can complicate virtually any surgical procedure. While SSI can result from numerous causes, contamination of the surgical field can also contribute to it. Intraoperative bacterial contamination during clean orthopaedic procedures can be detected using perioperative cultures. We hypothesized that perioperative cultures could be used to predict possibility of development of SSI in patients undergoing clean orthopaedic surgeries.

Materials and Methods We conducted a prospective cohort study at a tertiary care hospital over a 2-year period. Intraoperative surgical wound lavage fluid and closed suction drain tip obtained in the postoperative period were sent for aerobic culture. All patients were followed up to look for the development of SSI for a period of at least 30 days for those undergoing nonimplant surgery, and 90 days for those with implant surgery.

Statistical Analysis Means with standard deviation of the continuous data were calculated. Fisher's exact test and chi-square test were used for the analysis of the categorical variables. Relative risk and odds ratio were calculated to evaluate the association of the parameters under study with SSI.

Results A total of 384 patients satisfying the inclusion and exclusion criteria were included. Perioperative cultures detected surgical wound contamination in 39 patients (10.1%). Forty-five patients (11.7%) developed SSI during the follow-up period. Skin commensals constituted 59% of perioperative contaminants and accounted for 20% of the SSIs. The relative risk of developing SSI with perioperative contamination was 0.41 (95% confidence interval: 0.09–1.63).

Conclusion Intraoperative surgical-site contaminants could be detected using perioperative cultures. However, these contaminants did not lead to SSI. Timely treatment of perioperative contamination with appropriate antibiotics and local wound care probably helped in the reduction of SSI.

Keywords

Clean orthopaedic surgery - intraoperative contamination - surgical-site infection - perioperative - aerobic culture - SSI rate

Authors' Contribution

This submission represents honest and significant work from all authors. J.A.S. and S.P. conceived the idea for the study and designed the protocol. J.A.S., V.K.V., and P.B. performed the surgeries. S.P., A.G., and A.S. performed the microbiological laboratory tests. A.S. and U.A. collected the data. J.A.S., S.P., P.B., V.K.V., and A.S. were involved in the analysis and interpretation of the results. J.A.S. and P.B. wrote the first draft. All authors were involved in the editing of the manuscript and gave approval to the final draft.


Ethical Approval

Approval for the study was provided by the Institutional Human Ethics Committee of All India Institute of Medical Sciences, Bhopal, India (Reference no. IHEC-LOP/2015/IM0074).


This research was carried out at the All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.




Publication History

Article published online:
09 February 2022

© 2022. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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