To Örebro University

BACKGROUND: Surgical site infections are a global patient safety concern. Due to lack of evidence on contamination, pre-set surgical goods are sometimes disposed of or re-sterilized, thus increasing costs, resource use, and environmental effects.

AIM: To investigate time-dependent bacterial air contamination of covered and uncovered sterile goods in the operating room.

METHODS: Blood agar plates (n=1584) were used to detect bacterial air contamination of sterile fields on 48 occasions. Each time, three aerobe and three anaerobe plates were used as baseline to model the preparation time, and 60 (30 aerobe, 30 anaerobe) were used to model the time pending before operation; half of these were covered with sterile drapes and half remained uncovered. Plates were collected after 4, 8, 12, 16, and 24 hours.

FINDINGS: Mean time before contamination was 2.8 hours (95% CI: 2.1-3.4) in the uncovered group and 3.8 hours (95% CI: 3.2-4.4) in the covered group (P=0.005). The uncovered group had 98 colony-forming units (CFUs) versus 20 in the covered group (P=0.0001). Sixteen different microorganisms were isolated, the most common being Cutibacterium acnes followed by Micrococcus luteus. Of 32 Staphylococcus CFUs, 14 were antibiotic-resistant, including one multidrug-resistant S. epidermidis.

CONCLUSION: Protecting sterile fields from bacterial air contamination with sterile covers enhances the durability of sterile goods up to 24 hours. Prolonged durability of sterile goods might benefit patient safety, since surgical sterile material could be prepared in advance for acute surgery, thereby enhancing quality of care and reducing both climate impact and costs.