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      Perforation and Bacterial Contamination of Microscope Covers in Lumbar Spinal Decompressive Surgery

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          Abstract

          Objective

          To determine the integrity of microscope covers and bacterial contamination at the end of lumbar spinal decompressive surgery.

          Materials and Methods

          A prospective study of 25 consecutive lumbar spinal decompressions with the use of a surgical microscope was performed. For detection of perforations, the microscope covers were filled with water at the end of surgery and the presence of water leakage in 3 zones (objective, ocular and control panel) was examined. For detection of bacterial contamination, swabs were taken from the covers at the same locations before and after surgery.

          Results

          Among the 25 covers, 1 (4%) perforation was observed and no association between perforation and bacterial contamination was seen; 3 (4%) of 75 smears from the 25 covers showed post-operative bacterial contamination, i.e. 2 in the ocular zone and 1 in the optical zone, without a cover perforation.

          Conclusions

          The incidence of microscope cover perforation was very low and was not shown to be associated with bacterial contamination. External sources of bacterial contamination seem to outweigh the problem of contamination due to failure of cover integrity.

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          Most cited references14

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          Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries.

          Anand Veeravagu, Shivanand P. Lad, Maxwell Kwame Boakye … (2009)
          This is a multivariate analysis of a prospectively collected database. To determine preoperative, intraoperative, and patient characteristics that contribute to an increased risk of postoperative wound infection in patients undergoing spinal surgery. Current literature sites a postoperative infection rate of approximately 4%; however, few have completed multivariate analysis to determine factors which contribute to risk of infection. Our study identified patients who underwent a spinal decompression and fusion between 1997 and 2006 from the Veterans Affairs' National Surgical Quality Improvement Program database. Multivariate logistic regression analysis was used to determine the effect of various preoperative variables on postoperative infection. Data on 24,774 patients were analyzed. Wound infection was present in 752 (3.04%) patients, 287 (1.16%) deep, and 468 (1.89%) superficial. Postoperative infection was associated with longer hospital stay (7.12 vs. 4.20 days), higher 30-day mortality (1.06% vs. 0.5%), higher complication rates (1.24% vs. 0.05%), and higher return to the operating room rates (37% vs. 2.45%). Multivariate logistic regression identified insulin dependent diabetes (odds ratios [OR] = 1.50), current smoking (OR = 1.19) ASA class of 3 (OR = 1.45) or 4 to 5 (OR = 1.66), weight loss (OR = 2.14), dependent functional status (1.36) preoperative HCT 6 hours (OR = 1.40) as statistically significant predictors of postoperative infection. Using multivariate analysis of a large prospectively collected data from the National Surgical Quality Improvement Program database, we identified the most important risk factors for increased postoperative spinal wound infection. We have demonstrated the high mortality, morbidity, and hospitalization costs associated with postoperative spinal wound infections. The information provided should help alert clinicians to presence of these risks factors and the likelihood of higher postoperative infections and morbidity in spinal surgery patients.
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            Risk factors for surgical site infection following orthopaedic spinal operations

            MA Olsen, JJ Nepple, KD Riew … (2008)
            Article 0 comments Cited 48 times – based on 0 reviews     Review now
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              Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures.

              M Franzreb, H Gluch, M Ogon … (1998)
              A retrospective survey of 850 spinal procedures was conducted to determine risk factors for postoperative spinal infection. Some 574 posterior and 276 anterior procedures were evaluated. Infections were classed as early (within 19 weeks postoperatively) and late (> or = 20 weeks postoperatively), as well as deep and superficial infections. Previously postulated risk factors (i.e., diabetes, corticosteroid therapy, previous spinal surgery, obesity, chronic infection, and smoking) were investigated. Furthermore, it was hypothesized that three additional factors: extended preoperative hospitalization, prolonged operation duration, and high blood loss were risk factors not previously considered. A postoperative infection was evident in 22 of 850 procedures (19 early/three late infections, four superficial/18 deep infections). Most infections (n = 21) occurred with posterior instrumentation. Previously described factors were proven as risk factors. Extended preoperative hospitalization (p < 0.04), high blood loss (p < 0.01), and prolonged operation time (p < 0.001) were additionally determined as risk factors. The results suggest that routine prophylactic antibiotics might be unnecessary in anterior surgery, whereas extended prophylactics should be considered in posterior instrumentation, especially when risk factors are apparent.
              Article 0 comments Cited 46 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Princ Pract
                Journal ID (iso-abbrev): Med Princ Pract
                Journal ID (publisher-id): MPP
                Title: Medical Principles and Practice
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                ISSN (Print): 1011-7571
                ISSN (Electronic): 1423-0151
                Publication date (Print): July 2014
                Publication date (Electronic): 4 June 2014
                Publication date PMC-release: 4 June 2014
                Volume: 23
                Issue: 4
                Pages: 302-306
                Affiliations
                [1] aDepartment of Orthopedics, Balgrist Clinic, University of Zurich, Switzerland
                [2] bDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
                Author notes
                *Georg Osterhoff, MD, Department of Orthopedics, Balgrist Clinic, University of Zurich, Forchstrasse 340, CH-8008 Zurich (Switzerland), E-Mail georg.osterhoff@ 123456usz.ch
                Article
                Publisher ID: mpp-0023-0302
                DOI: 10.1159/000362794
                PMC ID: 5586899
                PubMed ID: 24903448
                SO-VID: 63111a6f-e3d7-4685-8542-f658adaa12c3
                Copyright © Copyright © 2014 by S. Karger AG, Basel
                License:

                This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.

                History
                Date received : 1 December 2013
                Date accepted : 10 April 2014
                Page count
                Figures: 3, Tables: 1, References: 15, Pages: 5
                Categories
                Subject: Original Paper

                Keywords: surgical infection,operation microscope,spine,decompression
                Data availability:
                Keywords: surgical infection, operation microscope, spine, decompression

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