2. What happens? ENDOPHTHALMITIS POST OPERATIVE

3. STOP IT NO

4. Prof.A.S.M.Kamal Uddin

5. DIAGNOSIS Clinical examination Conj.swab AC tap/Vit tap

6. CNS (coagulase-negative staphylococci)33 - 77 % BHS (ß-haemolytic streptococci), S. pneumoniae, ∂-haemolytic streptococci including S. mitis and S. salivarius 9 - 19 % Staphylococcus aureus10 - 21 % Gram-negative bacteria including Ps. aeruginosa (occurs rarely) 6 - 22 % (Candida sp., Aspergillus sp., Fusarium sp.) 8 %

7.  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, 308 - 312  Only 0.3-0.015% Post operative endophthalmitis  Significant % of apparent endoph cases Culture -VE

8.  75%-95% of reported cases Gm +ve Ophthalmology 1999;106:1869-77  Causative organisms after cataract Sx- Usually genetically Identical to Pt’s own flora Arch Ophthalmol1997; 115:357-361  8% Fungus

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

10. 29 – 43% 0.3-.015%

12. 191010.00 1970- 19900.12 (Europe) 0.072 (USA) 2000 -0.3 – 0.015

13. Month201120122013 January17339 February4113 March3118 April1125 May5027 June0013 July4028 August110 September120 October1748 November2268 December1339 88191155

14. History 2002 -20042005-2010 Patient age (yrs) 0–84 _>85 76/187 797 (0.040%) 32/37 673 (0.085%) 104/393 298 (0.026) 31/71 483 (0.043) Type of surgery Phaco with IOL Other than phaco with IOL † 101/220 658 (0.046%) 6/4107 (0.146%) 128/459 640 (0.028) 7/5221 (0.13) Incision type Sclerocorneal Clear corneal 27/74 087 (0.036%) 80/151 182 (0.053%) Intracameral cefuroxime Given Not given 100/223 156 (0.045%) 8/2315 (0.350%) 123/461 951 (0.027) 11/2804 (0.39) Communication with vitreous Absent Present 93/219 655 (0.042%) 14/5790 (0.242%) 127/456 973 (0.028) 8/7888 (0.1)

15.  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.

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

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

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

23. 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 ).

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

26. Select appropriate pt. Antibiotics prophylaxis Proper cleaning Povidone iodine

27. Cap masking

28.  Gowning  Gloving

29.  Disposables undraping

30.  Fluid soaked trolly

31.  Draping

32. ClusterEndemicIsolated Weakness of the protocol Disposables (liquid ) Sterilization failure

33. Month201120122013 January17339 February4113 March3118 April1125 May5027 June0013 July4028 August110 September120 October1748 November2268 December1339 88191155

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

36. দুশ্চিন্তাহীন মুক্ত জীবন