How contaminated might an operating room be?

What Orthopaedic Operating Room Surfaces Are Contaminated With Bioburden? A Study Using the ATP Bioluminescence Assay

These authors asked, in their hospital which of the orthopaedic operating room surfaces were contaminated with bioburden as indicated by adenosine triphosphate (ATP) bioluminescence, which detects the energy released when ATP breaks down into adenosine biphosphate (ADP) and phosphate (P).

Six different cleaned and prepared orthopaedic operating rooms were tested before surgery with an ATP bioluminescence assay kit.  A total of 13 different surfaces were sampled once in each room. The relative light units (RLUs) obtained from each sample were recorded and data were compiled and averaged for analysis. 

All surfaces had bioburden. The highest levels were the side of the OR table headboard, computer keyboard and  tourniquet machine buttons.

Comment: While these results show that living biomaterial was present on these surfaces, the study did not correlate the ATP bioluminescence with the results of cultures to determine what types of organisms were present and specifically if these surfaces contained known pathogens. For shoulder surgeons it would have been of great interest to know if these surfaces contained Propionibacterium.
These results come from one specific hospital, and may not apply to other hospitals which would have different environments and cleaning protocols.

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Do cell phones bring bacteria into the operating room? What about Propionibacterium? How much does it matter?

Investigation of Cell Phones as a Potential Source of Bacterial Contamination in the Operating Room

These authors estimate what we use cell phones 25-50 times per day to stay in touch with colleagues, patients, family and friends. The phones, like our lap tops, pens, caps and socks travel around with us and come in contact with organisms outside the OR. They asked whether the phones brought into the OR carried bacteria and whether a standardized disinfecting protocol could reduce the rate of bacterial contamination and the amount of organic material.

They cultured the front and back of 53 surgeon cell phones were swabbed for culture and for adenosine triphosphate bioluminescence to quantify organic material contamination. Phones were cleaned and retested. One week later, a final set of studies was obtained. 

Samples were cultured on 5% sheep blood agar incubated at 37°C in 5% CO2 and MacConkey agar incubated at 37°C in air. Plates were examined at twenty-four and forty-eight hours, and all colony types present were subjected to Gram stain and biochemical identification.

83% (forty-four cell phones) had pathogenic bacteria at initial testing, 8% (four cell phones) had pathogenic bacteria after disinfection, and 75% (forty cell phones) had pathogenic bacteria one week later. 

The cultured bacteria included coagulase negative staphylococcus, streptococcus viridans, staphylococcus auerus, and enterococcus fecalis as well as organisms thought to be 'non-pathogenic' (bacillus, micrococcus, corynebacterium, lactobacillus, paracoccus, and pseudomonas).

The bioluminescence at initial testing was 3488 ± 2998 relative light units, which reduced after disinfection to 200 ± 123 relative light units, indicating a cleaned surface, but increased one week later to 1825 ± 1699 relative light units, indicating a poorly cleaned surface.

Comment: Those of us shoulder surgeons would have been interested in knowing the relative presence of Propionibacterium were on these phones. Unfortunately, the fact that the cultures where only held for 2 days and that anaerobic media was not used keeps us from knowing the degree to which Propionibacterium were present.

There are many possible ways that bacteria may be introduced into a surgical wound. We would not think of cell phones as being the most likely vector. Rather we would focus on surgical caps (particularly non-disposable cloth hats), hair protruding from around the headwear, eye wear, surgical lights and other structures that are positioned over the surgical field as well as improperly sterilized instruments, contaminated and poorly applied drapes, anesthesiologists that do not cover their noses with masks, and many more before coming to cell phones.

Cleaning cell phones may be a good idea, but we want to be sure that energy is directed primarily to the 'usual suspects'.

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Use the "Search" box to the right to find other topics of interest to you.


You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

See the countries from which our readers come on this post.