title: Sterility of the personal protection system in total joint arthroplasty.
abstract: BACKGROUND
  Bacteria shed by operating room personnel is a source of wound contamination and postoperative infections. The personal protection system (PPS) was designed to decrease airborne bacteria and intraoperative contamination in total joint arthroplasty.
  
  
  OBJECTIVE
  We determined the microbial contamination rate of the PPS and incidence of contamination with key pathogens, Staphylococcus aureus and coagulase-negative staphylococci.
  
  
  METHODS
  We prospectively evaluated PPS contamination in 61 primary THAs and 41 TKAs. The PPS were assumed to be sterile before opening the packs. The initial culture was taken immediately after the hood was placed over the helmet. Four cultures were collected at the conclusion of the procedure. Plates were examined and colonies were classified according to Gram stain results and biochemical tests. S. aureus was classified as methicillin-resistant or -susceptible.
  
  
  RESULTS
  At time zero, 22 of 102 cultures isolated an organism, accounting for a contamination rate of 22%. The bacterial contamination rate of the PPS at the conclusion of the procedure was 47% (48 of 102). The relative percentage of the various organisms found was coagulase-negative staphylococci 50%, Micrococcus sp. 20%, methicillin-susceptible S. aureus 11%, and methicillin-resistant S. aureus (MRSA) 1%.
  
  
  CONCLUSIONS
  The external surface of the PPS cannot be assumed to be sterile after its removal from the original packaging. Of all the PPS studied, the potential pathogens coagulase-negative staphylococcus, S. aureus, and MRSA were found in 43%. This study supports the need to change gloves if the PPS is touched or adjusted during the procedure.
authors.affiliation: The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Kearns
authors.forename: Dan
authors.initials: D
authors.lastname: Witmer
authors.forename: Junaid
authors.initials: J
authors.lastname: Makda
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.forename: Donald
authors.initials: D
authors.lastname: Jungkind
mesh_terms: D019643:Arthroplasty, Replacement; D003030:Coagulase / Q000378:metabolism; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000517:prevention & control*; D011481:Protective Clothing / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control; D013210:Staphylococcus / Q000201:enzymology / Q000302:isolation & purification
chemical_list: D003030:Coagulase