+ All Categories
Home > Documents > What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

Date post: 17-Dec-2015
Category:
Upload: janel-sparks
View: 213 times
Download: 0 times
Share this document with a friend
Popular Tags:
36
WELCOME SYMPOSIUM OF BSCRS
Transcript
Page 1: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

WELCOME

SYMPOSIUM OF

BSCRS

Page 2: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

What happens?

ENDOPHTHALMITIS

POST OPERATIVE

Page 3: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

STOP ITNO

Page 4: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

DIAGNOSIS &PROPHYLAXIS OF

POST OPERATIVE ENDOPHTHALMITIS

Prof.A.S.M.Kamal Uddin

Page 5: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

DIAGNOSIS

•Clinical examination•Conj.swab•AC tap/Vit tap

Page 6: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

ESCRS meta analysis

CNS (coagulase-negative staphylococci)

33 - 77 %

BHS (ß-haemolytic streptococci), S. pneumoniae, ∂-haemolytic streptococci including S. mitis and S. salivarius

9 - 19 %

Staphylococcus aureus 10 - 21 %

Gram-negative bacteria including Ps. aeruginosa (occurs rarely)

6 - 22 %

(Candida sp., Aspergillus sp., Fusarium sp.)

8 %

Page 7: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

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

Page 8: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

SUMMARY

75%-95% of reported cases Gm +ve Ophthalmology 1999;106:1869-77

Causative organisms after cataract Sx-Usually genetically Identical to Pt’s own floraArch Ophthalmol1997; 115:357-361

8% Fungus

Page 9: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

BANGLADESH (IIEH)

Organism 2012No organism 140Gm +ve cocci 02Gm+ve bacilli 19fungus 15Total 180

Page 10: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

ENDOPHTHALMITIS

HOST RESISTANC

E

MICROBIAL POPULATION

VIRULANCE

29 – 43%

0.3-.015%

Page 11: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

INCIDENCES ( phaco era) escrs 2007

Page 12: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

PE SCENARIO ESCRS meta analysis

1910 10.001970- 1990 0.12 (Europe)

0.072 (USA)2000 - 0.3 – 0.015

Page 13: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

INCIDENCES (BANGLADESH)Month 2011 2012 2013January 17 3 39February 4 1 13March 3 1 18April 1 1 25May 5 0 27June 0 0 13July 4 0 28August 1 10  September 1 20  October 17 48  November 22 68  December 13 39    88 191 155

Page 14: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

RISK FACTORSSwedish National Cataract Register collected from 2002-2004 & 2005-2010

History 2002 -2004

2005-2010

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 surgeryPhaco with IOLOther than phaco with IOL†

101/220 658 (0.046%)6/4107 (0.146%)

128/459 640 (0.028)7/5221 (0.13)

Incision typeSclerocorneal Clear corneal

27/74 087 (0.036%)80/151 182 (0.053%)

Intracameral cefuroximeGiven Not given

100/223 156 (0.045%)8/2315 (0.350%)

123/461 951 (0.027)11/2804 (0.39)

Communication with vitreousAbsent Present

93/219 655 (0.042%)14/5790 (0.242%)

127/456 973 (0.028)8/7888 (0.1)

Page 15: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

RISK FACTORS

Older age of patientPreoperative topical antibioticsPovidone IodineMore time more manipulationVitreous face breakdownPhaco vs SICSCCI vs scleral incision Intra cameral injectionSubconj inj. Of Antibiotics.

Page 16: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

FLOW CHART – PROPHYLAXIS GUIDELINES(Based on the results of ESCRS multi-centre study as well as Healy et al.)

1• Topical

antibiotics 24 or 48 hours prior to surgery

2• Apply topical

antibiotic 1 hour and half-hour prior to surgery

3• Povidone iodine

minimum of three minutes

Page 17: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

4• Apply 10 per cent

povidone iodine to the peri-orbital area

5 • Surgeon washes hands properly

6 • Gloves and gowning properly

Page 18: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

7• Apply surgical drapes

properly

8• Perform

phacoemulsification surgery.

• Use foldable IOLs with sterile injector

9 •Apply inj cefuroxime (0.9 per cent) by intra-cameral injection at the end of surgery.

Page 19: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

10• Antibiotics in the

irrigation fluid not encouraged

11• Re-apply topical

antibiotics at the end of surgery

12

• Use of subconjunctival antibiotic is not thought to offer effective prophylaxis

Page 20: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

PITFALLS

OR protocolPatient relatedOT personal related OT assistant

Page 21: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

OR PROTOCOL

operating room (OR) layout and disinfection

sterile surgical protocolsterilisation of instruments

Page 22: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

Operating Room (OR) Layout and Disinfection Protocol

a)The outer zone b)The clean zone c)The aseptic

zone d)The disposal

zone

Page 23: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

Ventilation

The current United States Public Health Service minimum requirements:

Temperature between 18-24°C, Humidity 55-80%, and 25

changes per hourBacterial count of air should not

exceed l/ft3(35.5/m3).

Page 24: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

STERILE SURGICAL PROTOCOL

Air flow /AC ,Fan OT sterilization Oversrowding

Page 25: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

STERILE SURGICAL INSTRUMENTS

Page 26: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

PATIENT RELATED

• Select appropriate pt.

• Antibiotics prophylaxis

• Proper cleaning• Povidone iodine

Page 27: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

OT PERSONAL

•Cap masking

Page 28: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

GowningGloving

Page 29: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

OT ASSISTANT

Disposables undraping

Page 30: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

OT ASSISTANT

Fluid soaked trolly

Page 31: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

OT ASSISTANT

Draping

Page 32: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

MODE OF INCIDENCE

ClusterEndemi

c Isolated

Weakness of the

protocol

Disposables (liquid)

Sterilization failure

Page 33: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

INCIDENCES (BANGLADESH)Month 2011 2012 2013January 17 3 39February 4 1 13March 3 1 18April 1 1 25May 5 0 27June 0 0 13July 4 0 28August 1 10  September 1 20  October 17 48  November 22 68  December 13 39    88 191 155

Page 34: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

WHAT BSCRS CAN DO?

Task force – to trace out evidence

Information – through SMS/website etc

Microbial study of each lot of disposables

ETO sterilization plantEndophthalmitis study

Page 35: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.
Page 36: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO.

THANK YOU

দু�শ্চি�ন্তা�হী�ন মু�ক্ত জী�বন


Recommended