In Vitro Characterization of Lavage Splash and Effectiveness of Lavage Shield
BACKGROUND: Utilization of fluid to remove debris from surgical wounds has been a standard of medical care for centuries. Electrically powered pulse lavage systems are now regularly used to flush wounds in the operating room. This study aims to characterize splash patterns and contamination generated by different irrigation techniques commonly used in the treatment of surgical wounds.
METHODS: 4 different irrigation scenarios: gravity flow (GF), asepto bulb syringe (ABS), high pressure pulsatile lavage without splash shield (HPPL), and high pressure pulsatile lavage with splash shielding (HPPL-S) were conducted on a Sawbone® knee model anchored to a standard operating table in a fully operational operating room of a community hospital. Normal saline supplemented with Fluorescein dye was utilized as the fluid. The OR was divided into 4 quadrants and surveyed with a UV light source to characterize the presence of fluorescent fluid/droplets and radius of droplet displacement.
RESULTS: The HPPL trials contaminated the entire room with droplets that were too numerous to count. The HPPL-S trials reduced the number of droplets in quadrants outside of the “head right” quadrants, to a range of 0-12 droplets. In addition, the HPPL-S trial reduced the droplet distance to levels comparable to or below the GF and ABS droplet distance.DISCUSSION: This is the first study to characterize splash patterns seen with different irrigation systems. The addition of an inexpensive splashguard during high-pressure irrigation drastically reduced splash displacement. Decreased splash displacement theoretically reduces OR contamination and the resultant risk of nosocomial contamination.
Davol Simpulseâ„¢ Irrigation System. Available at: http://www.davol.com/products/surgical-specialties/orthopaedics/simpulse-irrigation-system . Accessibility verified November 4, 2013.
Heraeus Medical Palavage. Available at: http://heraeus-medical.com/en/produkte_1/zubehoer/palavage_1/palavage.aspx . Accessibility verified November 3, 2013.
Pulse Lavage. Available at: http://www.pulselavage.com . Accessibility verified November 4, 2013.
Stryker Pulsed Irrigation System. Available at: http://www.stryker.com/en-us/products/OREquipmentConnectivity/GeneralMultiSpecialtyEquipment/PulsedIrrigation/index.htm . Accessibility verified November 4, 2013.
Bahrs C, Schnabel M, Frank T, Zapf C, Mutters R, von Garrel, T. Lavage of contaminated surfaces: an in vitro evaluation of the effectiveness of different systems. J Surg Res. 2003; 112(1): 26-30.
Bhandari M, Adili A, Lachowski RJ. High pressure pulsatile lavage of contaminated human tibiae: an in vitro study. J Orthop Trauma. 1998; 12(7): 479-84.
Bhandari M, Schemitsch EH, Adili A, Lachowski RJ, Shaughnessy SG. High and low pressure pulsatile lavage of contaminated tibial fractures: an in vitro study of bacterial adherence and bone damage. J Orthop Trauma. 1999; 13(8): 526-33.
Bhandari M, Thompson K, Adili A, Shaughnessy SG. High and low pressure irrigation in contaminated wounds with exposed bone. Int J Surg Investig. 2000; 2(3): 179-82.
Bhaskar SN, Cutright DE, Gross A. Effect of water lavage on infected wounds in the rat. J Periodontol. 1969; 40(11): 671-2.
Brown LL, Shelton HT, Bornside GH, Cohn I. Jr. Evaluation of wound irrigation by pulsatile jet and conventional methods. Ann Surg. 1978; 187(2): 170-3.
Cutright DE, Bhaskar SN, Gross A, Perez B, Beasley JD 3rd, Mulcahey DM. Effect of vancomycin, streptomycin and tetracycline pulsating jet lavage on contaminated wounds. Mil Med. 1971; 136(10): 810-3.
Dancer SJ. Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis. 2008; 8(2): 101-13.
Dancer SJ, White LF, Lamb J, Girvan EK, Robertson, C. Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study. BMC Med. 2009; 7: 28.
Dharan S, Pittet D. Environmental controls in operating theatres. J Hosp Infect. 2002; 51(2): 79-84.
Dirschl DR, Duff GP, Dahners LE, Edin M, Rahn BA, Miclau T. High pressure pulsatile lavage irrigation of intraarticular fractures: effects on fracture healing. J Orthop Trauma. 1998; 12(7): 460-3.
Draeger RW, Dahners LE. Traumatic wound debridement: a comparison of irrigation methods. J Orthop Trauma. 2006; 20(2): 83-8.
Goodman ER, Platt R, Bass R, Onderdonk AB, Yokoe DS, Huang SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol. 2008; 29(7): 593-9.
Granick MS, Tenenhaus M, Knox KR, Ulm JP. Comparison of wound irrigation and tangential hydrodissection in bacterial clearance of contaminated wounds: results of a randomized, controlled clinical study. Ostomy Wound Manage. 2007; 53(4): 64-6, 68-70, 72.
Green VA, Carlson HC, Briggs RL, Stewart JL. A comparison of the efficacy of pulsed mechanical lavage with that of rubber-bulb syringe irrigation in removal of debris from avulsive wounds. Oral Surg Oral Med Oral Pathol. 1971; 32(1): 158-64.
Gross A, Cutright DE, Bhaskar SN, Perez B, Beasley JD 3rd. The effect of antibiotics and pulsating water jet lavage on contaminated wounds. Oral Surg Oral Med Oral Pathol. 1971; 31(1): 32-8.
Grower MF, Bhaskar SN, Horan MJ, Cutright DE. Effect of water lavage on removal of tissue fragments from crush wounds. Oral Surg Oral Med Oral Pathol. 1972; 33(6): 1031-6.
Hamer ML, Robson MC, Krizek TJ, Southwick WO. Quantitative bacterial analysis of comparative wound irrigations. Ann Surg. 1975; 181(6): 819-22.
Hardy K, Price C, Szczepura K, et al. Reduction in the rate of methicillin-resistant Staphylococcus aureus acquisition in surgical wards by rapid screening for colonization: a prospective, cross-over study. Clin Microbiol Infect. 2010; 16(4): 333-9.
Hassinger SM, Harding G, Wongworawat MD. High-pressure pulsatile lavage propagates bacteria into soft tissue. Clin Orthop Relat Res. 2005; 439: 27-31.
Hayden MK, Bonten MJ, Blom DW, Lyle EA, van de Vijver DA, Weinstein RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis. 2006; 42(11): 1552-60.
Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006; 6: 130.
Munoz-Mahamud E, Garcia S, Bori G, et al. Comparison of a low-pressure and a high-pressure pulsatile lavage during debridement for orthopaedic implant infection. Arch Orthop Trauma Surg. 2011; 131(9): 1233-8.
Munoz-Price LS, Birnbach DJ, Lubarsky SA, et al.:Decreasing operating room environmental pathogen contamination through improved cleaning practice. Infect Control Hosp Epidemiol. 2012; 33(9): 897-904.
Otter JA, Yezli S, French GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol. 2011; 32(7): 687-99.
Rodeheaver GT, Pettry D, Thacker JG, Edgerton MT, Edlich RF. Wound cleansing by high pressure irrigation. Surg Gynecol Obstet. 1975; 141(3): 357-62.
Rodeheaver GT, Smith SL, Thacker JG, Edgerton MT, Edlich RF. Mechanical cleansing of contaminated wounds with a surfactant. Am J Surg. 1975; 129(3): 241-5.
Rutala WA, Weber DJ. Guideline for disinfection and sterilization in healthcare facilities. Infect Control Hosp Epidemiol. 2010; 31(2): 107-17.
Stewart JL, Carlson HC, Briggs RL, Green VA. The bacteria-removal efficiency of mechanical lavage and rubber-bulb syringe irrigation in contaminated avulsive wounds. Oral Surg Oral Med Oral Pathol. 1971; 31(6): 842-8.
Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control. 2010; 38(5 Suppl 1): S25-33.
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Copyright (c) 2015 Steven Nishiyama, Ronald Hillock
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