How to Manage Intraoperative Contamination.

Sterile technique is essential to protect patients and decrease the risk of surgical site infections. Despite efforts to maintain sterility, sterile breaches occur. Examples of such breaches include holes in surgical drapes, insects in the operating room, residual bioburden on surgical instruments, dropped grafts intraoperatively, and defective sterile tray wrappers. Intraoperative sterile breaches are stressful situations for the surgical team and require the surgeon to make quick decisions that have a large impact on the patient's infection risk and outcome. There is limited literature to guide decisions regarding surgical sterility breaches. In this paper, we review the available literature to guide decisions when unexpected sterility breaches occur. Key Concepts: (1)Maintain a low threshold to reprocess contaminated equipment completely and take the most conservative actions possible if contamination occurs before incision.(2)Contamination after an incision requires careful evaluation of risks and benefits; it may be necessary to perform flash sterilization of critical equipment or decontamination of vital grafts with povidone-iodine or chlorhexidine.(3)Detection of defects in sterile drapes and gloves is limited, so extra vigilance is necessary.(4)Bio debris in orthopaedic instrumentation is common and poses a risk of contaminating the sterile field and increasing the chance of infection.(5)If pests are found in the OR, culture the insect and assess the OR infrastructure to determine the source of pest entry.