Contamination and Decontamination of Autologous Bone in the Operating Room: A Systematic Review

Objective: To perform a systematic review of the literature to determine the rate of contamination of autologous bone fragments inadvertently dropped on the operating room floor, the microbial profile (contaminating organism), and the outcome of intraoperative decontamination techniques in terms of effectiveness and cellular toxicity. Data Sources: PubMed, Medline, and Embase were searched for English literature published from 1990 through 2020 using terms such as "bone graft contamination," "dropped osteoarticular fragments," "autogenous bone decontamination," and similar interchangeable words. Study Selection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Inclusion criteria consisted of all studies on contamination of host bone fragments, means and/or rate of autologous bone contamination in operating rooms, microbial analysis of contaminated bone autograft, outcome of decontamination, and cellular viability after decontamination. Data Extraction: All potentially eligible studies underwent a full-text review and cross-referencing after title and abstract screening. Data on authors, publication year, study type, means and rate of contamination, microbial profile, decontamination technique, and effectiveness and cellular toxicity outcomes were extracted. Data Synthesis: Analysis and synthesis of data were performed on Microsoft Excel 2016. Conclusion: The rate of contamination for dropped osteoarticular or osteochondral host fragment approached 40%. Staphylococcus epidermidis was the most common organism contaminating the bone graft when dropped on the operating room floor. A 5-minute bath in 10% povidone-iodine solution followed by 1-minute bulb syringe lavage with normal saline has proved successful in decontamination and maintenance of cellular viability.