title: Supports used for positioning of patients in hip arthroplasty: is there an infection risk?
abstract: BACKGROUND
  Infection after joint arthroplasty is a disastrous complication. Implants used in hip arthroplasty increase the risk of infection from organisms of low pathogenicity. Potential reservoirs, that have not been assessed as yet, are the supports used for patient positioning in hip arthroplasty. The purpose of this study was to assess these supports for presence of bacterial pathogens.
  
  
  METHODS
  We studied 40 supports used in 20 hip arthroplasty procedures. Tryptone soya agar plates were used to sample these supports. All agar plates were incubated at 37 °C for 48 h.
  
  
  RESULTS
  Of the 20 anterior supports, 17 (85%) showed bacterial colonisation; of the 20 posterior supports, 10 (50%) had bacterial colonisation. Fourteen (52%) supports were contaminated with one organism, 9 (33%) with two organisms, three (11%) with three organisms and one (4%) with four organisms. Coagulase-negative staphylococci were the most common isolated organisms (61%) followed by coryneforms (10%) and bacilli (10%). Anterior supports had two times more colony forming units compared to the posterior supports.
  
  
  CONCLUSIONS
  This study showed contamination of supports used for positioning patients during hip arthroplasty. It reflects poor cleaning practice and certainly raises the possibility that a high bacterial load on these supports may contribute to higher infection rates in hip arthroplasties. The study raises concerns related to contamination of supports, as there is a potential for cross-infection, wound problems, and deep sepsis around implants which could be disastrous. While colonisation does not equate with infection, we suggest thorough cleaning of the supports before and after every surgical procedure.
authors.affiliation: Department of Orthopaedics, Weston General Hospital, Weston Super Mare, UK. riazhzi@yahoo.co.uk
authors.forename: Riaz
authors.initials: R
authors.lastname: Ahmad
authors.forename: Ji
authors.initials: J
authors.lastname: Tham
authors.forename: Syed Ghufran Ali
authors.initials: SG
authors.lastname: Naqvi
authors.forename: Umer
authors.initials: U
authors.lastname: Butt
authors.forename: John
authors.initials: J
authors.lastname: Dixon
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D001419:Bacteria / Q000302:isolation & purification*; D004866:Equipment Contamination; D004867:Equipment Design; D006801:Humans; D009983:Orthopedic Equipment / Q000382:microbiology*; D056888:Patient Positioning / Q000295:instrumentation*; D016459:Prosthesis-Related Infections / Q000209:etiology*; D012307:Risk Factors