At some point in our lives, most of us have dropped food on the ground, quickly picked it up, and ate it – the classic “five-second rule.” Should surgical teams apply the same “rule” when an instrument hits the floor in the OR?
Most healthcare providers likely would think not, but a randomized study of disinfection approaches for contaminated arthroplasty implants sought clarity on this scenario. The conclusion? Disinfect anything that hits the floor if you intend to use it. But which disinfectant should be used? Researchers found some work better than others.
The study, published last week in Infection Control & Hospital Epidemiology, notes, “The so-called ‘five-second rule’ has been debunked in food safety, yet a similar mindset persists in surgical environments. Implant drops are not uncommon with 61.5% occurring during emergency procedures. Despite the frequency, guidelines for managing dropped implants have not been established.”
The prospective, randomized controlled bench study was conducted during orthopedic surgeries in four ORs at Duke University Medical Center in Durham, N.C., between June and July 2025. Immediately following a primary hip or knee arthroplasty case, polyethylene liners were aseptically and gently placed on the OR floor for 10 seconds where the surgeon had stood.
The study then assessed the efficacy of three disinfectant types on the liners by comparing bacterial contamination counts before and after immersion in sterile preparations of chlorhexidine-alcohol (CHG), povidone-iodine (PI), or ethanol.
The researchers write, “Polyethylene liners dropped onto operating room floors rapidly acquire bacterial contamination, including clinically important pathogens. In a randomized bench study, sterile chlorhexidine-alcohol and povidone-iodine immersion significantly reduced bioburden compared with ethanol or no intervention. When replacement is not feasible, chlorhexidine or iodine is preferable.”
Read the full study here.
