Past research has found 3 in 5 surgical instruments accidentally fall during emergency orthopedic procedures, but the healthcare industry lacks guidelines on managing this contamination risk, according to researchers at Duke University Health System in Durham, N.C.
The researchers intentionally doubled the five-second rule to investigate the efficacy of three disinfectants for an instrument often used in orthopedic procedures. They published their findings March 26 in Infection Control & Hospital Epidemiology.
“The so-called ‘five-second rule’ has been debunked in food safety, yet a similar mindset persists in surgical environments,” the researchers wrote in the study’s introduction, adding that operating room floors and other surfaces are frequently colonized by pathogens.
In simulations of real-world scenarios, 213 polyethylene liners from hip or knee implants were “gently placed” on OR floors for 10 seconds immediately after a surgeon stood during an arthroplasty procedure. The researchers then collected floor sponge samples from the drop sites and swabbed the implants.
Compared to implants that were not disinfected, those that were sterilized in chlorhexidine-alcohol or povidone-iodine had fewer clinically important pathogens, such as Staphylococcus aureus, while implants sterilized in ethanol did not perform better than the control group.
“Even with [chlorhexidine-alcohol or povidone-iodine], disinfection did not guarantee sterility, indicating residual risk. Therefore, a dropped PE liner should be replaced,” the researchers concluded. “Patients should be informed of the event and monitored for signs of infection.”
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