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Introduction: Pulsed lavage during a total knee replacement usually leaves a pool of fluid on the surgical drapes. It is common practice to suck away this fluid using the same suction device used intra-operatively. This could be a cause of direct wound contamination. We hypothesised that bacteria contaminate fluid that collects around the foot in total knee replacement surgery and that suction equipment could be a portal of contamination. We also hypothesised that bacterial count in the fluid is lower if chlorhexidine, rather than saline, is used in the pulsed lavage., Patients and Methods: Forty patients undergoing primary total knee replacement were divided into two groups. The first group had pulsed lavage with normal saline and the second with 0.05% chlorhexidine., Results: At the end of the operation, 20 ml of fluid, pooled on the surgical drapes was aspirated and cultured for bacterial growth. None of the fluid samples showed bacterial growth., Conclusions: Suction device used peri-operatively during knee replacement is unlikely to be a cause of wound contamination. Pulsed lavage with normal saline is as effective as lavage with chlorhexidine.

Introduction: Operating department staff are usually required to wear dedicated theatre shoes whilst in the theatre area but there is little evidence to support the beneficial use of theatre shoes., Patients and Methods: We performed a study to assess the level of bacterial contamination of theatre shoes at the beginning and end of a working day, and compared the results with outdoor footwear., Results: We found the presence of pathogenic bacterial species responsible for postoperative wound infection on all shoe groups, with outdoor shoes being the most heavily contaminated. Samples taken from theatre shoes at the end of duty were less contaminated than those taken at the beginning of the day with the greatest reduction being in the number of coagulase-negative staphylococcal species grown. Studies have demonstrated that floor bacteria may contribute up to 15% of airborne bacterial colony forming units in operating rooms. The pathogenic bacteria we isolated have also been demonstrated as contaminants in water droplets spilt onto sterile gloves after surgical scrubbing., Conclusions: Theatre shoes and floors present a potential source for postoperative infection. A combination of dedicated theatre shoe use and a good floor washing protocol controls the level of shoe contamination by coagulase-negative staphylococci in particular. This finding is significant given the importance of staphylococcal species in postoperative wound infection.