The Learning Center

Contamination Problem

Foreign body contamination can result in benign changes, severe complications, and in some cases death. 3,4,6,16

Starch contamination has been snuffed out. Now it’s time to lose the lint.

Cellulose fibers, lint, released from commonly used sterile cotton products like cotton surgical towels, gauze, non-adherent TELFA™ pads, RAY-TEC® sponges, and lap pads are documented sources of foreign body contamination.
 

Lint from cotton products can be introduced into patients four ways:

  1. Contact Transfer: Cotton products used in the procedure come into contact with the medical device which includes transfer from the handler’s gloves and draped standard cotton surgical towels.
  2. Fluid Transfer: When cotton products (i.e. gauze, TELFA, etc.) are dunked in bowls and fluid to wipe instruments, and the same fluid is drawn up and used for sheath, catheter flushing, or as irrigation in a wound/incision.
  3. Airborne Transfer: When standard cotton products shed particulates into the air that land on a device or in a wound/incision.
  4. Direct Transfer: When cotton products (i.e. RAY-TEC sponges, standard lap pads, etc.) are placed directly in the wound or incision.

Linting cotton products used in interventional procedures have been documented to cause the following complications, and others:
  • occlusive granulomas
  • infection
  • necrosis
  • arteritis or aterial occlusion
  • infarct
  • stroke
  • phlebitis
  • kidney failure
  • seizures
  • misdiagnosed carcinomas
  • death
Complications more commonly associated with linting cotton products used in open body cavity surgery:
  • granulomas
  • adhesions
  • infection
  • death

The number of bacteria needed to initiate an infection drops from ~100,000 to ~100 when foreign body debris is present.18

Presentations about fiber and lint transmission and contamination

Syntervention offers products designed to eliminate preventable lint and fiber contamination.

Many medical devices, particularly implants and intravascular devices, are manufactured to strict requirements concerning cleanliness, particulate, and fiber content. However, once the sterile medical devices are opened for a procedure, they become exposed to a number of foreign bodies and contaminating elements, primarily cotton based products previously described.

Essentially the cleanliness, particulate, and fiber requirements the device was manufactured to no longer benefits the patient when the device is subjected to the elements in the operating room or the interventional lab.  Therefore, it is imperative, that the operator and support staff keep the sterile medical devices and instruments as clean as possible prior to every insertion into a patient’s body.

 

SWASHER Ultra Low-Lint Surgical Towel
SWIPER Medical Device Foam Wiper
GUIDE-KLIP Medical Device Retaining Tool
Reference Articles
Video Library
Syntervention in the Press
The SWASHER
The SWIPER
The GUIDE-KLIP
Video Library
Literature Review
Syntervention in The News

Articles and Presentations by Syntervention

Article published in Endovascular Today, October 2014:  Keeping the Room out of the Patient [pdf]

Article published in Endovascular Today, September 2012:  Foreign Body Contamination During Interventional Procedures [pdf]

Podium presentation at New Cardiovascular Horizons 6/9/12:  Microscopic Foreign Body Contamination during Interventional Procedures [pdf]

Poster presentation from CVPath: Pathologic Identification of Foreign Materials Associated with Cardiovascular Interventional Devices [pdf]

Review of fiber and lint contamination literature: Publication Review of Cotton Fiber Contamination 2025[pdf]

New fiber-free products address an under-recognized danger to patients: The Catastrophic Impact of Cotton Fiber Contamination in Surgical Procedures [pdf]

Additional Supporting Documents

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  2. Belkin NL. Bacterial Penetration vis-à-vis lint generation. J Hosp Infect. 2002;52(4): 315-7.
  3. Belkin NL. The role of surgical gowns, drapes, and masks in the generation of airborne particulates. AORN J. 2000;72(4):678-681.
  4. Beyene RT. Intra-abdominal adhesions. Anatomy, physiology, pathophysiology, and treatment. Curr Probl Surg 2015 Jul;52(7):271-319
  5. Bookstein JJ. Experimental investigation of hypercoagulant conditions associated with angiography. J Vasc Interv Radiol 1995;6(2):197–204.
  6. Chapot R. Occlusion of the middle cerebral artery due to synthetic fibers. Am J Neuroradiology 2006;27(1):148–50.
  7. Chason JL. Cotton fiber embolism, a frequent complication of cerebral angiography. Neurology 1963;13:558-60.
  8. Chun KC. Infection Following Total Knee Arthroplasty. Knee Surg Relat Res. 2013;25(3):93-99.
  9. Dimmik JE. Fiber embolization--a hazard of cardiac surgery and catheterization. N Engl J Med. 1975;292(13):685-7.
  10. di Zerega GS. Contemporary adhesion prevention. Fertil Steril 1994;61,219-35.
  11. Dragan MJ. Wood fibers from disposable surgical gowns and drapes. JAMA 1979;241:2297-2298.
  12. Duron JJ. Post-operative peritoneal adhesions and foreign bodies. Eur J Surg 1997;579(Suppl)15-6.
  13. Duron JJ. Foreign bodies and intraperitoneal post-operative adhesions. J Long Term Eff Med Implants. 1997;7(3-4):235-42.
  14. Edmiston C. Airborne particulates in the OR environment. AORN J. 1999;69(6): 1169-79.
  15. Elek SD. The virulence of Staphylococcus pyogenes for man: a study of the problems of wound infections. Br J Exp Pathol.1957;38:573-86. Br J Exp Pathol 1957;38:573-86
  16. Ellis H. The Causes and Prevention of Intestinal Adhesions. Br J Surg 1982;69(5):241-3.
  17. Fischi M. Coronary embolization of a gauze fragment: A cautionary case report. Catheterization and Cardiovascular Interventions. 2005;66:570-2.
  18. Glasgow D. Lint shedding cannot be overlooked. Clinical Services Journal. 2003;Aug: 28-30.
  19. Headon H. Capsular contraction after breast augmentation: and update for clinical practice. Arch Plas Surg. 2015:42(5):532-43.
  20. Heath D. Case reports: Cotton-Wool Granuloma of Pulmonary Artery. British Heart Journal 1962;24(4);518-20.
  21. Holton M. Microscopic foreign body contamination. Abstract presented at: New Cardiovascular Horizons 2012; June 9, 2012; New Orleans, LA.
  22. Huebner GD. Wood fiber contamination of reusable cotton laparotomy pads. Surgery, Gynecology and Obstetrics. 1979;148(June) 887-889.
  23. Janoff K. Foreign body reactions secondary to cellulose lint fibers. Am J Surg. 1984;147(5):598-600.
  24. Jeekel H. Cost implications of adhesions as highlighted in a European study. EUR J Surg Suppl. 1997;579):43-5.
  25. Laird JR. Foreign Body Contamination During Interventional Procedures. Endov Today. Sept 2012.
  26. Laird JR. Keeping the room out of the patient: reducing the risk of foreign body embolization procedures. Endov Today. Octo 2014
  27. Liakakos T. Peritoneal adhesions: Etiology, pathophysiology and clinical significance. Digestive Surg 18:260-273.
  28. Luijendijk RW. Foreign material in the post-operative adhesions. Ann Surg 1996;223:242-48.
  29. Menzies D, Ellis H. Intestinal Obstruction from Adhesions--How Big Is the Problem? Ann R Coll Surg Engl 1990; 72(1):60-3.
  30. Menzies D. Peritoneal Adhesions. Incidence, Cause, and Prevention. Surg Annu 1992; 24Pt 1:27-45.
  31. Mladicck RA. ”Nor-touch” Submuscular saline breast augmentation technique. Aesthtic Plast Surg. 1993;17(3):183-92.
  32. Mori H. Catastrophic Consequence of Gauze During Percutaneous Coronary Intervention. JACC 2017; 10(15) e141-142
  33. Morimoto M. Expansively hemorrhagic foreign body granuloma at the pelvis caused by microscopic materials. Open J Orthopedics. 2012;2:1-5.
  34. Oloff LM. In Chapter 24 First Metatarsophalangeal Implants pp. 338 in Hetherington V., Hallux Valgus and Forefoot Surgery. 1994 Churchill Livingston Pub. Philadelphia PA., ISBN-13: 978-0443087752.
  35. Pajkos A. Detection of subclinical infection in significant breast implant capsules. Plast Reconstr Surg 2003;111:1605–11.
  36. Ramot Y. Foreign Body Granulomas within Intramyocardial Arteries in a Trans coronary Safety Assessment in Pigs. Toxicologic Pathology 2008;36:385-7.
  37. Sari A. The Potential of Microscopic Sterile Sponge Particles to Induce Foreign Body Reaction. International Wound Journal 2006;3:363-8.
  38. Shannon P. Inadvertent foreign body embolization in diagnostic and therapeutic cerebral angiography. Am J Neuroradiology 2006;27:278–82.
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