污染灭菌空心器械可能与关节镜术后感染相关：一项系统综述
简介
该系统综述纳入14项研究（6项基础研究、8项临床研究；数据库检出193条记录中纳入12项，参考文献补充2项），评估带管腔骨科手术器械的灭菌情况。基础研究显示，被认为无菌的带管腔器械管腔常存在污染；8项临床研究均为病例系列，报告了常规膝或肩关节镜（1项）、由内向外半月板修复（1项）及ACL重建（6项）术后感染聚集。带管腔器械管腔污染可能与关节镜术后感染聚集相关…
英文摘要
PURPOSE: To systematically review the literature regarding sterilization of cannulated orthopaedic surgical instruments. METHODS: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, LENS.ORG (filters: journal articles, surgery and infectious diseases, and medicine and surgery), Google Scholar (first 10 pages), and EMBASE databases were independently searched by 2 researchers using the terms "sterilization cannulated surgical instruments." We included English-language, peer-reviewed clinical and basic science reports of any level of evidence, published in PubMed-cited journals regarding sterilization of cannulated instruments used for orthopaedic surgery. We excluded review articles, book chapters, conference abstracts, non-English-language reports, unpublished manuscripts, and reports focused on noncannulated, or nonorthopaedic, instruments. Studies were characterized as basic science or clinical studies and summarized in tables and by narrative review. RESULTS: Database search identified 193 records; 12 were included. Screening of references identified 2 additional included articles. Six included studies were basic science; 8 were clinical. Basic science studies investigated various techniques for one or both steps required for sterilization: washing and autoclaving. All clinical studies were case series reporting clusters of infections after routine knee or shoulder arthroscopy (1 report), inside-out meniscal repair (1 report), or anterior cruciate ligament reconstruction (6 reports). Epidemiologic investigation was performed in all cases. CONCLUSIONS: Contaminated lumens of supposedly sterile orthopaedic instruments are frequently demonstrated in basic science studies and may be associated with clusters of clinical infections after arthroscopic procedures. CLINICAL RELEVANCE: Cannulated surgical instruments pose a challenge to sterilization because viable microorganisms (including bacteria, yeast, and mold) and protein (including prions) may remain. Such contamination may result in infections and is a modifiable risk factor. Implementation of clinical protocols, including enhanced cleaning and sterilization of cannulated instruments, is required to prevent or remediate such contamination.