Bacterial contamination of surgical blades, suction tips, and iodophor drapes in primary joint arthroplasty

Intraoperative bacterial contamination may contribute to microbial transmission during joint arthroplasty, but its distribution across surgical devices and clinical significance remain uncertain. This study aimed to characterize intraoperative bacterial contamination, compare contamination-positive and contamination-negative patients, evaluate contamination across device types, and assess postoperative infection outcomes. This prospective cohort study included 127 patients undergoing primary joint arthroplasty between February 2016 and April 2017. Samples from an unused control blade, skin-incision blade, deep-tissue blade, povidone–iodine-impregnated drape, and suction tip underwent aerobic and anaerobic culture. Patients were classified according to whether at least 1 specimen yielded bacterial growth. Patient-level characteristics were compared between contamination-positive and contamination-negative groups. Device-specific contamination was compared using generalized estimating equations (GEE) to account for within-patient correlation. Patients were followed for 24 to 38 months. A total of 13 of 127 patients (10.2%) had at least 1 positive culture. After exclusion of suspected sampling or transport contamination, positivity rates were 1.7% for control blades, 5.9% for skin-incision blades, 0.8% for deep-tissue blades, 2.5% for povidone–iodine-impregnated drapes, and 2.6% for suction tips. Patient-level demographic, surgical, and comorbidity characteristics did not differ significantly between groups. Overall contamination rates differed significantly among device types (GEE Wald χ 2 = 15.14, df = 4; P = .004), although no individual device differed significantly from the control blade; for skin-incision blades, OR = 3.65 (95% CI, 0.73–18.27; P = .116). No surgical-site infections, periprosthetic joint infection, or deep soft-tissue infection occurred during follow-up. Intraoperative bacterial contamination occurred across multiple surgical devices despite standardized perioperative measures, with overall contamination rates differing by device type. Skin-incision blades had the highest observed positivity rate, but no device showed a statistically significant increase versus the control blade. The absence of postoperative infection underscores the distinction between microbiological contamination and clinical infection.