title: Contaminant seeding in bone by different irrigation methods: an experimental study.
abstract: OBJECTIVE
  This study was designed to investigate the effectiveness of using various devices and manual procedures for cleansing bacterially contaminated bone tissue and to assess the risk of iatrogenic bacterial seeding in deep bone layers.
  
  
  METHODS
  In an in vitro model, human femoral heads were contaminated with Escherichia coli and then cleansed with pulsatile high-pressure lavage, pulsatile low-pressure lavage, manual rinsing with bulb syringe lavage, or manual rinsing with combined brush cleaning. The numbers of bacteria that remained or those that were introduced by the rinsing procedures were quantitatively determined at depths of 0 to 1 cm, 1 to 2 cm, and 2 to 3 cm.
  
  
  RESULTS
  Both pulsatile high-pressure lavage and brush cleaning were more effective than pulsatile low-pressure lavage and bulb syringe lavage for the purpose of surface cleansing. The differences were highly significant (P < 0.001). There was no significant difference in the decontaminating effect between pulsatile high-pressure lavage and brush cleaning (P = 0.24). The bacterial contamination attributable to the cleansing procedure, as measured at tissue depths of 1 to 2 cm and 2 to 3 cm, was significantly higher after pulsatile high-pressure lavage and after pulsatile low-pressure lavage than it was after bulb syringe lavage or brush cleaning (P < 0.001).
  
  
  CONCLUSIONS
  In this in vitro investigation of cancellous bone, the brush cleansing was just as effective for getting rid of bacterial contamination as pulsatile high-pressure lavage, and carries a significantly lesser risk of iatrogenic bacterial seeding into deeper tissue layers. In the light of these promising results obtained by the cleansing of cancellous bone contaminated with bacteria, it would be desirable to perform supplementary in vitro and in vivo investigations into brush cleansing.
authors.affiliation: Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl V.-Allee 3, D-93077 Bad Abbach, Germany. thomas.kalteis@klinik.uni-regensburg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Kalteis
authors.forename: Norbert
authors.initials: N
authors.lastname: Lehn
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Schröder
authors.forename: Thomas
authors.initials: T
authors.lastname: Schubert
authors.forename: Stefan
authors.initials: S
authors.lastname: Zysk
authors.forename: Martin
authors.initials: M
authors.lastname: Handel
authors.forename: Joachim
authors.initials: J
authors.lastname: Grifka
mesh_terms: D000368:Aged; D004203:Disinfection / Q000379:methods*; D004927:Escherichia coli Infections / Q000209:etiology / Q000382:microbiology* / Q000517:prevention & control*; D005260:Female; D005269:Femur / Q000382:microbiology / Q000601:surgery; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D010000:Osteitis / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000209:etiology / Q000382:microbiology* / Q000517:prevention & control*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome