Reducing the Risk of Postoperative Eye Infections

Abstract BACKGROUND: Post-cataract endophthalmitis is rare ( OBJECTIVE: The objective was to reduce the rate of endophthalmitis to less than one per 1000 cases. METHODS: Endophthalmitis cases were defined as either infection or severe inflammation of the ocular cavity and its adjacent structures diagnosed upon the first or second postoperative visit. The microbiology of infections was reviewed. Surgical case observations were initiated to include review of surgical preps, solutions, technique, equipment, sterility, medications, and multidose use. Interventions were initiated to reduce the infection rate. RESULTS: Five cases were confirmed due to S. aureus, S. pneumoniae , and coagulase-negative Staphylococcus. Because the infections are temporally spaced in two places and involved different pathogens, intrinsic rather than extrinsic contamination was most likely. Surgical preps were observed with obvious variations in technique and total disinfectant contact time. We reviewed the standard of practice with both operating room staffs, and reinforced using multiple sterile applicators for the surgical prep from the least contaminated area (eye) outward to the most contaminated area (nose and eyebrow). The application of iodophor was initiated earlier to insure a minimum 5 minutes of contact. Among 1150 subsequent cases, no infections have been prospectively identified. CONCLUSIONS: The outbreak likely resulted from intrinsic patient flora. Staff education in proper surgical prep techniques and adequate contact time are essential to preventing postoperative endophthalmitis.