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Compressed-Air Power Tools in Orthopaedic Surgery: Exhaust Air Is a Potential Source of Contamination

Objectives To determine if the exhaust from surgical compressed-air power tools contains bacteria and if the exhaust leads to contamination of sterile surfaces. Design Bacteriologic study of orthopaedic power tools. Setting Level I trauma center operative theater. Patients/Participants None. Intervention Part I. Exhaust from two sterile compact air drills was sampled directly at the exhaust port. Part II. Exhaust from the drills was directed at sterile agar plates from varying distances. The agar plates represented sterile surfaces within the operative field. Part III. Control cultures. A battery-powered drill was operated over open agar plates in similar fashion as the compressed-air drills. Agar plates left open in the operative theater served as controls to rule out atmospheric contamination. Random cultures were taken from agar plates, gloves, drills, and hoses. Main Outcome Measurement Incidence of positive cultures. Results In Part I, all filters from both compressed-air drill exhausts were culture negative (p = 0.008). In Part II, the incidence of positive cultures for air drills number one and number two was 73% and 82%, respectively. The most commonly encountered organisms were Staphylococcus epidermidis, coagulase-negative Staphylococcus, Staphylococcus cohnii, Diphtheroid bacillus, and Micrococcus species. All control cultures from agar plates, battery-powered drill, gloves, and hoses were negative (p < 0.01). Conclusions Exhaust from compressed-air power tools in orthopaedic surgery may contribute to the dissemination of bacteria onto the surgical field. We do not recommend the use of compressed-air power tools that do not have a contained exhaust.