Povidone-iodine and saline wash provide best decontamination with minimal cellular toxicity
THURSDAY, March 17 (HealthDay News) -- Effective decontamination of autologous bone fragments which are accidentally dropped during operations can be achieved with minimal toxicity by using a povidone-iodine solution followed by a saline solution rinse, according to a study published in the March 2 issue of The Journal of Bone & Joint Surgery.
Benjamin Bruce, M.D., from Rhode Island Hospital in Providence, and colleagues established a three-phase evaluation of intraoperative methods of managing acutely contaminated, nondisposable, autologous osteoarticular bone fragments. Phase I analyzed the microbial profile and contamination rate of 162 human osteoarticular fragments that were dropped onto the operating room floor. Phase II assessed the feasibility of decontamination by treating 340 contaminated fragments using operating room cleansing agents. Phase III evaluated the effect of decontamination on chondrocyte viability using histological examination.
The investigators identified a 70 percent contamination rate in Phase I, with coagulase-negative Staphylococcus the most common of the 28 cultures. In Phase II, mechanical saline-solution scrubbing prevented coagulase-negative Staphylococcus growth better than simple lavage. Decontamination by bactericidal agents was superior to normal saline solution. Povidone-iodine or 4 percent chlorhexidine gluconate were most effective; after decontamination there was no positive culture growth from the specimens identified in Phase I. In Phase III, treatment with povidone-iodine and normal saline solution yielded the highest number of live cells and lowest number of dead cells. Chondrocyte viability was significantly decreased with mechanical scrubbing compared to saline-solution wash (P < 0.05).
"This study provides guidance on treatment of dropped osteoarticular fragments during surgery in order to decrease the rate of contamination and infection," the authors write.
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