Sat., 10/15/11 Peds, Ger, Hip, Femur & IP, Paper #81, 11:49 am OTA-2011
Beyond the 5-Second Rule: What To Do With Drop-Contaminated Bone?
Chad A. Krueger, MD1; Daniel J. Stinner, MD1; Brendan D. Masini, MD1;
Joseph C. Wenke, PhD2; LTC Joseph R. Hsu, MD2;
1Brooke Army Medical Center, Fort Sam Houston, Texas, USA;
2United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
Purpose: The purpose of this study was to quantify the reduction in the bacterial burden of grossly contaminated bone segments using different chlorhexidine solutions. We hypothesize that 4% chlorhexidine will be the most efficient decontaminate.
Methods: 54 diaphyseal bone segments were harvested from 16 cadaveric porcine legs. Each specimen was dropped onto a Mueller-Hinton medium that was inoculated with Staphylococcus aureus (lux). These genetically engineered bacteria emit photons in proportion to their number, allowing for quantification. The bone segments were retrieved after 5 seconds, simulating the act of dropping a bone segment onto a nonsterile surface. Baseline imaging was obtained to determine the initial bacterial load on each segment. The specimens were then divided into 3 groups and an equal number of specimens were soaked in normal saline (NS), 2% chlorhexidine (2%CHL), or 4% chlorhexidine (4%CHL). Specimen reimaging occured at the 5, 10, 20, 30, and 60-minute marks.
Results: The average bacterial count on the bone segments were: 2.18 × 107 for NS, 2.31 °— 107 for 2%CHL, and 2.00 × 107 for 4%CHL. The percent reduction in bacterial counts at the 5, 10, 20, 30, and 60-minute marks were NS: 0%, 0%, 0%, 29.84%, 72.23%; 2%CHL: 93.09%, 98.16%, 99.21%, 99.63%, 99.81%; and 4%CHL: 94.32%, 97.60%, 99.25%, 99.63%, 99.82%. At all time intervals, there was a significant difference between the 2%CHL and 4%CHL groups compared to the NS group (P <0.0001) and no difference between the 2%CHL and 4%CHL groups.
Conclusions: Gross contamination of a critical segment of bone during an operative procedure or by traumatic extrusion can have a devastating impact on reconstruction. This is especially true when dealing with periarticular bone or in cases where replacement options are limited. To maximize efficiency and decrease potential untoward effects, we recommend 20-minute soaks using 2% chlorhexidine for contaminated bone segments.
Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army, Department of Defense, or the US government. This work was prepared as part of their official duties and, as such, there is no copyright to be transferred.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.