Contamination rate of the surgical gowns during total hip arthroplasty

Arch Orthop Trauma Surg. 2019 Jul;139(7):1015-1019. doi: 10.1007/s00402-019-03211-w. Epub 2019 May 24.


Introduction: Surgical instrument contamination during total joint replacement is a matter of major concern. Available recommendations suggest changing suction tips, gloves and avoiding light handle manipulation during the procedure. There is a paucity of data regarding surgical gown contamination. The aim of the present study was to evaluate the contamination rate of surgical gowns (SGs) during total hip arthroplasty (THA) and secondarily compare it with other orthopedic procedures.

Materials and methods: One hundred and forty surgical gowns (from 70 surgeries) were screened for bacterial contamination using thioglycolate (a high-sensitivity culture broth). The THA contamination rate was compared with those of knee and spine procedures. Controls were obtained at the beginning of every surgery and from the culture broth. The procedure's duration and the level of training of the surgeon were evaluated as potential risk factors for contamination.

Results: Bacterial contamination was identified on 12% of surgical gowns (22% of surgical procedures). The contamination rate during THA was 4.1% (2% in primary THA and 8.3% in revisions) vs 21.67% during other surgeries (spine and knee) (OR 6.15, p = 0.012). There were no contaminated SGs during THAs performed in ≤ 2 h (0/33 SGs) vs 7.5% (3/40) for THAs that took ≥ 2 h (p = 0.25).

Conclusion: There was a high rate of SG contamination during orthopedic procedures that was higher during non-arthroplasty procedures and prolonged THAs. There were no contaminated surgical gowns in THAs under 120 min, efforts should point keeping primary THAs under this cutoff time. As a general recommendation, SGs should be changed every time there is concern about potential contamination.

Keywords: Complications; Periprosthetic joint infection; Revisions; Surgical field contamination; Surgical gowns.

MeSH terms

  • Arthroplasty, Replacement, Hip* / adverse effects
  • Arthroplasty, Replacement, Hip* / methods
  • Bacteria / isolation & purification*
  • Bacteriological Techniques / methods
  • Chile / epidemiology
  • Equipment Contamination* / prevention & control
  • Equipment Contamination* / statistics & numerical data
  • Humans
  • Infection Control / methods
  • Operative Time
  • Risk Factors
  • Surgical Attire* / adverse effects
  • Surgical Attire* / microbiology
  • Surgical Wound Infection* / epidemiology
  • Surgical Wound Infection* / etiology
  • Surgical Wound Infection* / prevention & control