骨科手术器械的微生物学分析（翻译有奖）

潮水

Analysis of the microbial load in instruments used in orthopedic surgeries
American Journal of Infection Control
Volume 38, Issue 3, Pages 229-233 (April 2010)
Background
Because of advances in technology, the number of orthopedic surgeries, mainly hip and knee replacement surgeries, has increased, with a total of 150,000 prosthetic surgeries estimated per year in the United States and 400,000 worldwide.

Methods
We used an exploratory cross-sectional study, with a quantitative approach to determine the microbial load in instruments used in orthopedic surgeries, quantifying and identifying the microbial growth genus and species, according to the surgical potential of contamination that characterizes the challenge faced by the Material and Sterilization Center at the Institute of Orthopedics and Traumatology of Hospital das Clinicas of the School of Medicine of the University of Sao Paulo, Brazil.The orthopedic surgical instruments were immersed, after their use, in sterilized distilled water, sonicated in an ultrasonic washer, and posteriorly agitated. Subsequently, the wash was filtrated through a 0.45-μm membrane and incubated in aerobic and anaerobic mediums and in medium for fungi and yeasts.

Results
In clean surgeries, 47% of the instruments were contaminated; in contaminated surgeries, 70%; and, in infected surgeries, 80%. Regardless of the contamination potential of the surgeries, the highest quantitative incidence of microorganism recovery was located in the 1 to 100 colony-forming unit range, and 13 samples presented a microbial growth potential >300 colony-forming units. Regardless of the contamination potential of the surgeries, there was a convergence in the incidence of negative-coagulase Staphylococcus growth (28%, clean surgeries; 32%, contaminated surgeries; and 29%, infected surgeries) and Staphylococcus aureus (28%, contaminated surgeries; and 43%, infected surgeries).

Conclusion
Most of the microorganisms recovered from the analyzed instruments (78%) were vegetative bacteria that presented their death curve at around 80°C, characterizing a low challenge considering the processes of cleaning and sterilization currently employed by the Material and Sterilization Center. Fewer microorganisms were recovered from instruments used in clean surgeries in comparison with those used in contaminated and infected surgeries.

Key Words: Hospital infection, orthopedic surgery, surgical instruments, microbial load

wjllulu

由于技术的进步，接受整形外科手术，主要是髋关节和膝关节置换手术的患者人数在增加，每年在美国估计进行１５万例这种手术，全球约40万例。
　　
方法：巴西圣保罗大学医学院骨伤研究所消毒供应中心对该中心接受的骨伤手术器械进行了微生物污染定量和定性研究。应用一个跨部门的实验，用定量的方法来确定骨科手术器械中微生物的负载量，然后根据不同手术潜在的污染特点进行定性培养以确定微生物的属种。首先将使用后的骨科整形手术器械浸泡在无菌蒸馏水中，然后用超声波机进行震荡，再搅动。随后通过一个0.45微米的过滤膜将水滤净，剩余物质则分别置入需氧、厌氧培养基、真菌和酵母菌培养基中。

结果：清洁手术器械中47％有微生物生长，非清洁手术的器械70％有（微生物）污染，感染手术中80％有污染。微生物污染数量从1CFU到100CFU不等，其中13个标本的微生物> 300cfu。尽管外科手术有潜在的微生物污染，但发现了较集中发生的凝固酶阴性葡萄球菌污染（洁净手术28％，非洁净手术32％和感染手术29％，）和金黄色葡萄球菌污染（非洁净手术28％和感染手术43％）。

结论：本实验中大部分手术器械（78％）有细菌生长的，它们的死亡曲线在80℃左右，按照目前该中心的清洗和消毒方法，要达到灭菌效果是基本上无问题的。洁净手术后器械的微生物污染比非洁净和感染手术要更少。

可能存在很多错误，请潮水老师指导