100.
Should the knife be discarded after skin incision in arthroplasty
surgery?
Casper Ottesen, Annette Skovby, Henrik Husted, Alice Friis-Møller, Anders
Troelsen
Dept. Of Orthopaedic Surgery Hvidovre University Hospital; Dept. of Clinical
Microbiology, Hvidovre University Hospital; Dept. Of Orthopaedic Surgery,
Hvidovre University Hospital; Dept. of Clinical Microbiology, Hvidovre
University Hospital ; Dept. Of Orthopaedic Surgery, Hvidovre University
Hospital
Background:
Postoperative infection following hip or knee arthroplasty
surgery is a serious complication with major economic and personal
consequences. Bacterial contamination from the skin to the deeper tissues is a
potential risk factor for postoperative infections. Traditionally, the knife has
been discarded after skin incision because of its possible role as a vector for
bacteria.
Purpose / Aim of Study:
To evaluate the level of contamination of a skin
knife and a knife used separately for incision of the deeper layers in hip and
knee arthroplasty surgery, to re-assess whether or not a separate skin knife
should be used to prevent deep contamination and potential infection.
Materials and Methods:
We collected three knives from every primary knee
and hip arthroplasty surgery in non-laminar airflow operating rooms: The knife
used for the skin incision, the one used for the rest of the operation and one
control knife (placed on the operating table), were all sent in sterile BHI media
for bacteriological examination.
Findings / Results:
A total of 831 knife blades from 277 patients were
cultured. We found growth from the skin knife from eight patients (2.8%),
growth from the ”deep” knife from five patients (1.8%) and growth from the
control knife from five patients (1.8%). In one case both the skin knife and the
”
deep” knife grew the same microorganism.
Conclusions:
Our findings suggest a very low rate of skin contamination. All
three types of knives showed contamination which underlines that total
surgical sterility is impossible to achieve. To this date (> 3 months post-
operative), none of the patients, who had contamination of one or more knives,
have shown signs of postoperative infection. Our findings do not support
discarding the knife after the skin incision in order to prevent postoperative
infection in elective orthopedic arthroplasty surgery.
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