“Oops, I Did It Again”

Commentary The study by Corbaz et al. supplies experimental evidence regarding a common problem. Urgent sterilization has become difficult and has been amplified in scope and importance in the last 20 years by the complexities of operating room (OR) sterilization procedures. The centralization of sterile processing in hospital and outpatient surgical departments has been further complicated by these large processes occurring off-site from where patient care takes place. Chemical disinfection of surgical instruments is not new. In the mid-1800s, there was a slow evolution from antiseptics to steam sterilization and heated dry air. This relentless path of improved science, promoted by Lister, resulted in surgical instrument sterilization, which was first introduced by von Bergmann in 18911. Since >130 years ago, some process involving steam sterilization—which today involves high heat and high temperature, or “pressure cooker” methods—has been the gold standard. It has supplanted most chemical sterilization. Unfortunately, added sterile processing aimed at maximum decontamination has created a complicated and rigid process for the resterilization of instruments and orthopaedic implants. Guidelines for OR sterilization methods have mostly been promulgated by de facto regulatory bodies, including government agencies and professional organizations. These regulations combine to create rigid systems with strict guidelines that few wish to deviate from in the high-stakes world of perioperative infection control. In real-world scenarios, gravity is not just a good idea but a law of physics. Objects in the OR hit the floor or come into contact with objects outside the sterile field. When this occurs and the surgical device or instrument in question is mission-critical, the operation grinds to a halt. Spare instruments, if readily available, and replacement implants, if included with the imported implant sets, are the first choice for surgeons. However, in this world of multiple ORs and expensive, unique sets of instruments that are intended for 1 purpose, spare or replacement parts may not be readily available. As shown in this wonderful article by Corbaz et al., chemical disinfection with any of 3 alcohol solutions effectively decontaminated discs of metal and polyethylene. Decontamination using these solutions was reliable and fast, both of which are essential elements when making surgical decisions on how to solve the problem in front of oneself. The surgeon is still master and commander in the OR. This type of data will help surgeons to make difficult decisions when faced with the normally irreconcilable problem of a missing part or implant that has halted a complex procedure. Off-site decontamination, central processing, a rigid workflow, and complex instrument sets all contribute to difficult choices when immediate decontamination is needed. Despite the reliability of steam sterilization, some instruments and OR setups do not allow for “flash sterilization,” which has gone out of vogue and thus is not routinely approved for use by OR staff. The health and safety of the patient are paramount at all times. Corbaz et al. have given us a tool to use as a last resort when faced with a mission-critical part that is missing due to accidental contamination. Although a properly processed replacement is still the first choice, chemical decontamination is an effective tool for mitigating the risk of infection in these instances of contamination.