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. 2020 Jul 26;14(2):153-159.
doi: 10.1055/s-0040-1714434. eCollection 2022 Apr.

Sterility of Miniature C-arm Fluoroscopy in Hand and Upper Extremity Surgery

James P Hovis  1 , Stephanie N Moore-Lotridge  1 , Ashton Mansour  1 , Breanne H Y Gibson  2 , Douglas R Weikert  1 , Mihir J Desai  1 , Sandra S Gebhart  1 , Jonathan G Schoenecker  1   2   3   4 , Donald H Lee  1
Affiliations

Sterility of Miniature C-arm Fluoroscopy in Hand and Upper Extremity Surgery

James P Hovis et al. J Hand Microsurg. .

Abstract

Previous studies have demonstrated that sterile equipment is frequently contaminated intraoperatively, yet the incidence of miniature c-arm (MCA) contamination in hand and upper extremity surgery is unclear. To examine this incidence, a prospective study of MCA sterility in hand and upper extremity cases was performed in a hospital main operating room (MOR) ( n = 13) or an ambulatory surgery center operating room (AOR) ( n = 16) at a single tertiary care center. Case length, MCA usage parameters, and sterility of the MCA through the case were examined. We found that MOR surgical times trended toward significance ( p = 0.055) and that MOR MCAs had significantly more contamination prior to draping than AOR MCAs ( p < 0.001). In MORs and AORs, 46.2 and 37.5% of MCAs respectively were contaminated intraoperatively. In MORs and AORs, 85.7 and 80% of noncontaminated cases, respectively, used the above hand- table technique, while 50 and 83.3% of contaminated MOR and AOR cases, respectively, used a below hand-table technique. Similar CPT codes were noted in both settings. Thus, a high-rate of MCA intraoperative contamination occurs in both settings. MCA placement below the hand-table may impact intraoperative contamination, even to distant MCA areas. Regular sterilization of equipment and awareness of these possible risk factors could lower bacterial burden.

Keywords: Miniature C-arm; contamination; hand; infection; surgery; surgical contamination.

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Conflict of interest statement

Conflict of Interest J.G.S. reports that he is a member of the education advisory board at OrthoPediatrics; is a member of the POSNA board; receives research funding from Orthopediatrics; receives research support in the form of materials from IONIS pharmaceuticals; receives research support from PXE international. Authors’ Contributions J.P.H.: Wrote the manuscript with support from S.N.M.L., D.H.L., and J.G.S. Contributed to interpretation of results and data presentation. S.N.M.L.: Assisted with project design and preparation of IRB materials, performed data analysis, assisted in manuscript preparation, and headed up data analysis and figure preparation. A.M.: Contributed to sample collection and data analysis. B.H.Y.G.: Contributed to sample collection and data analysis. D.R.W.: Conducted surgical cases and assessed and contributed to sample collection and data analysis. M.J.D.: Conducted surgical cases and assessed and contributed to sample collection and data analysis; assisted with project design and preparation of IRB materials. S.S.G.: Devised the project and main conceptual ideas presented within; assisted with project design and preparation of IRB materials, and aided in interoperating the results. J.G.S.: Devised the project and main conceptual ideas presented within; provided funding for experimental examinations, aided in interpreting results, and offered critical revisions of the manuscript. D.H.L.: Assisted in manuscript presentation, aided in interpreting results, offered critical revisions, and supervised collection of data.

Figures

Fig. 1
Fig. 1
( A ) MCA being used in above hand-table technique with primary surgeon, assistant, and scrub technician. ( B ) MCA being used in below hand-table technique with primary surgeon, assistant, and scrub technician. MCA, miniature c-arm.
Fig. 2
Fig. 2
( A ) X-ray tube (top) portion of the MCA. ( B ) Middle portion of the MCA. ( C ) Image intensifier (bottom) portion of the MCA. MCA, miniature c-arm.
Fig. 3
Fig. 3
( A ) Comparison of surgery length, median case length–MOR ( n = 13): 142.4 minutes (range: 40–293 minutes); AOR ( n = 16): 95. 1 minutes (range: 38–327 minutes); p = 0.055, ns. ( B ) Number of times MCA approached the surgical field, MOR ( n = 13): median = 5 approaches (range: 1–13 approaches); AOR ( n = 11): median = 2 approaches (range: 1–15 approaches); p = 0.273, ns, ( C ) and time of MCA use, median usage time (seconds)–MOR ( n = 11): 187 seconds (range: 16–1441 seconds); AOR 285 ( n = 10): 139 seconds (range: 19–1221 seconds); p = 0.468, ns. AOR, ambulatory operating room; MCA, miniature c-arm; MOR, main operating room.
Fig. 4
Fig. 4
(A-D) Comparison of CFUs collected prior to draping of MCAs in MOR and AOR settings. AOR, ambulatory operating room; CFU, colony- forming unit; MCA, miniature c-arm; MOR, main operating room.
Fig. 5
Fig. 5
Incidence of MCA contamination in MOR cases ( n = 13). ( A ) Percentage of cases where contamination was identified at either the start of the case after draping or at the end of the case. ( B ) Analysis of MCA location in negative or positive contamination cases. Contamination defined as > 2 CFUs across all locations assessed. CFU, colony-forming unit; MCA, miniature c-arm; MOR, main operating room.
Fig. 6
Fig. 6
Incidence of MCA contamination in AOR cases ( n = 16). ( A ) Percentage of cases where contamination was identified at either the start of the case after draping or at the end of the case. ( B ) Analysis of MCA location in negative or positive contamination cases. Contamination defined as > 2 CFUs across all locations assessed. AOR, ambulatory operating room; CFU, colony-forming unit; MCA, miniature c-arm.
Fig. 7
Fig. 7
Comparison of contamination after the completion of a case between MOR ( n = 6) ( A ) and AOR ( n = 6) ( B ). Pink indicates cases where above hand-table technique was used; purple indicates cases where below hand-table technique was used. Number indicates CFUs found at each location assessed upon case completion. Only cases with positive contamination are plotted. AOR, ambulatory operating room; CFU, colony-forming unit; MOR, main operating room.
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