Bacterial contamination of the surgical field during major orthopaedic procedures: is this a cause for concern?

BACKGROUND

Bacterial contamination of surgical suction tips during orthopaedic surgery may indicate intra-operative microbial exposure, but its predictive value for surgical site infections (SSIs) is unclear.

AIM: The aim of this study was to evaluate the incidence of suction tip contamination, its association with SSIs and related risk factors in major orthopaedic procedures.

METHODS

This prospective cohort study included 760 patients undergoing major orthopaedic surgery (February 2022-March 2024) in a large secondary care hospital. Suction tip fragments were aseptically collected post procedure and cultured. SSIs were monitored for ≥90 days. Binary logistic regression identified associations between contamination, SSIs, and risk factors.

FINDINGS: Suction tip contamination occurred in 3.55% of cases; SSIs developed in 0.66% of cases. No significant association was found between contamination and SSI. Spinal surgery increased odds of both contamination (odds ratio [OR]: 4.485, 95% confidence interval [CI]: 1.989-10.113) and SSI (OR: 10.810, 95% CI: 1.783-65.555). Longer operative time (OR: 1.030, 95% CI: 1.011-1.049), an American Society of Anesthesiologists (ASA) sore of 3 (OR: 0.136, 95% CI: 0.023-0.823), higher body mass index (OR: 1.197, 95% CI: 1.053-1.360) and immunosuppression (OR: 10.236, 95% CI: 1.089-96.213) were associated with increased SSI risk.

CONCLUSION

Suction tip contamination is not uncommon but does not predict SSIs. Spinal procedures, prolonged surgery, and patient comorbidities are stronger SSI predictors. Suction tip cultures may indicate environmental contamination but have limited clinical use as standalone SSI predictors. Prevention should target multi-factorial risks, especially in high-risk procedures.