What happens? ENDOPHTHALMITIS POST OPERATIVE

STOP IT NO

Prof.A.S.M.Kamal Uddin

DIAGNOSIS Clinical examination Conj.swab AC tap/Vit tap

CNS (coagulase-negative staphylococci) % BHS (ß-haemolytic streptococci), S. pneumoniae, ∂-haemolytic streptococci including S. mitis and S. salivarius % Staphylococcus aureus % Gram-negative bacteria including Ps. aeruginosa (occurs rarely) % (Candida sp., Aspergillus sp., Fusarium sp.) 8 %

 29%- 43% intraocular contamination occurs with facultative pathogenic bacteria Sherwood, D. R., Rich, W. J., Jacobs, J. S., Hart, R. J., Fairchild, Y. L.: Bacterial contamination of intraocular and extraocularfluids during extracapsular cataract extraction. Eye 3, 1989,  Only % Post operative endophthalmitis  Significant % of apparent endoph cases Culture -VE

 75%-95% of reported cases Gm +ve Ophthalmology 1999;106:  Causative organisms after cataract Sx- Usually genetically Identical to Pt’s own flora Arch Ophthalmol1997; 115:  8% Fungus

Organism2012 No organism140 Gm +ve cocci02 Gm+ve bacilli19 fungus15 Total180

29 – 43% %

(Europe) (USA) – 0.015

Month January17339 February4113 March3118 April1125 May5027 June0013 July4028 August110 September120 October1748 November2268 December

History Patient age (yrs) 0–84 _>85 76/ (0.040%) 32/ (0.085%) 104/ (0.026) 31/ (0.043) Type of surgery Phaco with IOL Other than phaco with IOL † 101/ (0.046%) 6/4107 (0.146%) 128/ (0.028) 7/5221 (0.13) Incision type Sclerocorneal Clear corneal 27/ (0.036%) 80/ (0.053%) Intracameral cefuroxime Given Not given 100/ (0.045%) 8/2315 (0.350%) 123/ (0.027) 11/2804 (0.39) Communication with vitreous Absent Present 93/ (0.042%) 14/5790 (0.242%) 127/ (0.028) 8/7888 (0.1)

 Older age of patient  Preoperative topical antibiotics  Povidone Iodine  More time more manipulation  Vitreous face breakdown  Phaco vs SICS  CCI vs scleral incision  Intra cameral injection  Subconj inj. Of Antibiotics.

 OR protocol  Patient related  OT personal related  OT assistant

 operating room (OR) layout and disinfection  sterile surgical protocol  sterilisation of instruments

 a)The outer zone  b)The clean zone  c)The aseptic zone  d)The disposal zone

The current United States Public Health Service minimum requirements:  Temperature between 18-24°C,  Humidity 55-80%, and 25 changes per hour  Bacterial count of air should not exceed l/ft 3 (35.5/m 3 ).

 Air flow /AC,Fan  OT sterilization  Oversrowding

Select appropriate pt. Antibiotics prophylaxis Proper cleaning Povidone iodine

Cap masking

 Gowning  Gloving

 Disposables undraping

 Fluid soaked trolly

 Draping

ClusterEndemicIsolated Weakness of the protocol Disposables (liquid ) Sterilization failure

Month January17339 February4113 March3118 April1125 May5027 June0013 July4028 August110 September120 October1748 November2268 December

 Task force – to trace out evidence  Information – through SMS/website etc  Microbial study of each lot of disposables  ETO sterilization plant  Endophthalmitis study

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