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WELCOME. SYMPOSIUM OF BSCRS. What happens?. POST OPERATIVE. ENDOPHTHALMITIS. STOP IT. NO. Prof.A.S.M.Kamal Uddin. DIAGNOSIS &PROPHYLAXIS OF POST OPERATIVE ENDOPHTHALMITIS. DIAGNOSIS. Clinical examination Conj.swab AC tap/ Vit tap. ESCRS meta analysis. SUMMARY.
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WELCOME SYMPOSIUM OF BSCRS
What happens? POST OPERATIVE ENDOPHTHALMITIS
STOP IT NO
Prof.A.S.M.KamalUddin DIAGNOSIS &PROPHYLAXIS OF POST OPERATIVE ENDOPHTHALMITIS
DIAGNOSIS Clinical examination Conj.swab AC tap/Vit tap
SUMMARY • 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
SUMMARY • 75%-95% of reported cases Gm +veOphthalmology 1999;106:1869-77 • Causative organisms after cataract Sx-Usually genetically Identical to Pt’s own flora Arch Ophthalmol1997; 115:357-361 • 8% Fungus
ENDOPHTHALMITIS 29 – 43% 0.3-.015%
RISK FACTORSSwedish National Cataract Register collected from 2002-2004 & 2005-2010
RISK FACTORS • Older age of patient • Preoperative topical antibiotics • Povidone Iodine • More time more manipulation • Vitreous face breakdown • Phacovs SICS • CCI vsscleral incision • Intra cameral injection • Subconj inj. Of Antibiotics.
FLOW CHART – PROPHYLAXIS GUIDELINES(Based on the results of ESCRS multi-centre study as well as Healy et al.)
PITFALLS • OR protocol • Patient related • OT personal related • OT assistant
OR PROTOCOL • operating room (OR) layout and disinfection • sterile surgical protocol • sterilisation of instruments
Operating Room (OR) Layout and Disinfection Protocol • a)The outer zone • b)The clean zone • c)The aseptic zone • d)The disposal zone
Ventilation 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/ft3(35.5/m3).
STERILE SURGICAL PROTOCOL • Air flow /AC ,Fan • OT sterilization • Oversrowding
PATIENT RELATED • Select appropriate pt. • Antibiotics prophylaxis • Proper cleaning • Povidone iodine
OT PERSONAL • Cap masking
Gowning • Gloving
OT ASSISTANT • Disposables undraping
OT ASSISTANT • Fluid soaked trolly
OT ASSISTANT • Draping
MODE OF INCIDENCE Isolated Endemic Cluster Weakness of the protocol Disposables (liquid) Sterilization failure
WHAT BSCRS CAN DO? • 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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