An Analysis of the Effectiveness of High-level Disinfection for Surgical Instruments Used by Department of Defense Austere Surgical Teams

ABSTRACT Introduction The purpose of this investigation was to evaluate the efficacy of currently employed commercial disinfectants in a simulated austere surgical environment similarly faced by ground surgical teams in forward deployed positions. Severe contamination of traumatic combat wounds along with limitations of operations in austere environments may result in available disinfectants providing inadequate surgical instrument decontamination. Materials and Methods The study consisted of nine experimental groups and two control groups evaluating hemostatic forceps found in kits of ground surgical teams. Hemostats were contaminated in a manner replicating the use in austere wartime surgery, cleaned by manual debridement and soaked in a disinfectant. Initially, instruments were debrided in one of three initial liquids (potable water, sterile water, or potable water with Envirocleanse A) and subsequently treated with one of three terminal disinfectants (Cidex OPA, CaviCide, or Neutral Disinfectant Cleaner). Treated hemostats were placed in sterile wire-closure bags for various storage times and tested for viable bacteria measured by colony-forming units. Results Our findings indicated that mechanical debridement in water, independent of Envirocleanse A, followed by soaking in any of the three terminal disinfectants achieved a marked reduction in recovered bacteria from hemostats regardless of storage length. Of the three disinfectants tested, Cidex OPA appeared to be the most robust in terms of decontamination, followed by CaviCide and Neutral Disinfectant Cleaner. Conclusions This study supports the conclusion that all evaluated disinfectants are capable of rapidly producing instruments with minimal bacterial contaminants when standard sterilization is unavailable. Therefore, when lifesaving surgical intervention must be performed in a deployed environment, austere surgical teams can confidently utilize either product with minimal risk of infection. However, of the disinfectants, Cidex OPA appears to be most effective in reducing bacterial contamination for both rapid and slow turnover of instrument usage, and thus, the disinfectants are recommended for application when sterilization is not available.