Gloves Contamination During Revision Surgery for Periprosthetic Joint Infection

Background The use of double-gloving has become a standard practice for joint replacement surgeons to minimize intraoperative contamination and lower the risk of periprosthetic joint infection (PJI). However, since there is limited data on how gloves are contaminated during both primary and revision arthroplasty, no precise protocol exists to direct surgeons on when, or if, to change their gloves. The goals of this preliminary study were to evaluate the contamination of gloves during total joint arthroplasties (TJA) in an effort to provide evidence to guide future studies on glove changing protocols. Methods A preliminary study looking at sources of intraoperative cross-contamination was performed on either infected cases or primary arthroplasty. We included 25 infected cases and 10 primaries, which were performed at the same institution using the same surgical protocol from three fellowship trained surgeons. Samples were taken every 20 minutes from the start of the surgery until the joint was irrigated. Procedural steps were noted. To evaluate cross-contamination during infected cases, we sampled gloves using blood agar plates. In primary cases, culture swabs of anterior chamfer cuts and sterile instruments on the back table were used as negative controls. Next generation sequencing was used as an adjunct to identify low virulence bacteria. Results In the primary cases, all samples were found culture negative but 3 (8.1%) of the 37 samples were found have a low, unidentifiable bacterial mass via NGS testing. n the infected cases, 41 (59.4%) of the 69 samples yielded positive microbial results. The positivity rate was higher in the samples collected after the arthrotomy was performed (70%) compared to samples collected before the arthrotomy was performed (40%) and the surgeon was only dissecting superficial layers (p=0.502). Conclusion Gloves seem to be a common source of cross-contamination in the intraoperative field during revision TJA. Due to the higher percent of positive samples following the opening of the joint, we hypothesize that the arthrotomy allows for the spread of bacteria across the operative site. While further investigation is necessary to formulate a precise protocol for the changing of gloves during TJA, it may be beneficial to perform a thorough irrigation of the joint and change of the gloves immediately following arthrotomy.