Disinfection of human musculoskeletal allografts in tissue banking: a systematic review.
Musculoskeletal allografts are typically disinfected using antibiotics, irradiation or chemical methods but protocols vary significantly between tissue banks. It is likely that different disinfection protocols will not have the same level of microorganism kill; they may also have varying effects on the structural integrity of the tissue, which could lead to significant differences in terms of clinical outcome in recipients. Ideally, a disinfection protocol should achieve the greatest bioburden reduction with the lowest possible impact on tissue integrity. A systematic review of three databases found 68 laboratory and clinical studies that analyzed the microbial bioburden or contamination rates of musculoskeletal allografts. The use of peracetic acid-ethanol or ionizing radiation was found to be most effective for disinfection of tissues. The use of irradiation is the most frequently published method for the terminal sterilization of musculoskeletal allografts; it is widely used and its efficacy is well documented in the literature. However, effective disinfection results were still observed using the BioCleanse™ Tissue Sterilization process, pulsatile lavage with antibiotics, ethylene oxide, and chlorhexidine. The variety of effective methods to reduce contamination rate or bioburden, in conjunction with limited high quality evidence provides little support for the recommendation of a single bioburden reduction method.
Canadian Blood Services, 270 John Savage Ave., Dartmouth, NS, B3B 0H7, Canada.
J
J
Mohr
Héma-Québec, 1070 Sciences-de-la-Vie Avenue, Quebec, QC, G1V 5C3, Canada.
M
M
Germain
Nelson Laboratories, 6280 South Redwood Road, Salt Lake City, UT, 84123-6600, USA.
M
M
Winters
Canadian Blood Services, 270 John Savage Ave., Dartmouth, NS, B3B 0H7, Canada.
S
S
Fraser
Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada.
A
A
Duong
Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada.
A
A
Garibaldi
Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada.
N
N
Simunovic
Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada.
D
D
Alsop
Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada.
D
D
Dao
Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada.
R
R
Bessemer
Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada. Ayenif@mcmaster.ca.|McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada. Ayenif@mcmaster.ca.
O R
OR
Ayeni
D064591:Allografts / Q000382:microbiology* / Q000821:virology*; D016025:Bone Transplantation / Q000009:adverse effects; D001842:Bone and Bones / Q000382:microbiology / Q000821:virology; D018929:Cell Culture Techniques / Q000379:methods; D004203:Disinfection / Q000379:methods*; D006801:Humans; D009132:Muscles / Q000382:microbiology / Q000637:transplantation* / Q000821:virology; D013242:Sterilization / Q000379:methods*; D014015:Tissue Banks; D014184:Transplantation, Homologous
Bioburden; Musculoskeletal allograft; Tissue banking; Tissue donation
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