Contaminated Sterilized Cannulated Instruments May Be Associated With Infections After Arthroscopic Surgery: A Systematic Review

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 We excluded review articles, book chapters, conference abstracts, non-English-language reports, unpublished manuscripts, and reports focused on noncannulated, or nonorthopaedic, instruments.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.