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All India Ophthalmological Society issued guidelines for prevention and prophylaxis of the most devastating complication of intra ocular surgery , namely post operative infectious endophthalmitis .
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AIOS Guidelines For Prevention of post Operative
Intraocular infections
Dr.NSD RajuTeam AIOS
I have no financial interests or relationships to disclose
Endophthalmitis
Preoperative Measures
• Blood glucose level: less than 200 mg/dL
Systemic Blood Pressure: less than 150/90
mmHg
External Eye Examination
• Meticulous external eye examination• Infection of adnexia• No routine syringing• No surgery - if regurgitation of pus
Preop Measures
• Physicians clearance (Cardiac hepatic neurological Renal HIV Endocrine )
Pre operative Measures
Topical antibiotics 4th generation fluoroqinolones 4 times 2
days prior to surgery
Camp/Large Volume surgery
Usual precautions for SurgeryPhysicians clearance
Avoid Patients with high risk systemic problemsCombined surgery to be avoided
Operative Measures
Pulse oximeter Anesthetist stand by Emergency Drugs Operating microscope
Dedicated Ophthalmic O T
Lay out Outer zone- receptionClear zone- ChangingRoom transfer zoneAseptic zone
The Surgeon and Assistant
Sterile gloves for every caseChange gown at least after 5 cases No street clothes in O R
General Operative Measures
Staff with obvious infection not allowed Standard protocol for hand washing gowning Betadine/ Chlorhexidine Running water aqua guard No contact procedures tonometry biometryFresh Phaco tip for each caseNot more than 25 cases/session
Pre operative Patient Preparation
Postpone surgery if congestion or discharge in the eyeO T dress for the patient with capBetadine 5% skin periorbital area and conjunctial sac 3 mtsDisposable drape isolate the lashes
Post Operative
Patching optionalTopical anesthesia no patchingFollow up visit 1 3 7 and 30 daysSlit lamp evaluationProtective glasses 1 wkTopical antibiotics and steroid eye drops for minimum 4 weeks
Documentations
Document all procedures and clinical findingsSurgeon available at the hospital for at least 1 w
Important Considerations
• Max 5 personnel in O R per 180 sq ft• Fumigation -Sterility of OR thorough AldeKol -For 400 sq ft 325 ml sprayed for 30 mts - Close the OR for 2 hrs - switch on the AC for 2 hrs -Theatre ready in 3 hrs
Fumigation
Three fumigations for the first timeRunning OT single fumigationProtocol: 30 ml of 40% formalin in 90 ml of clean water6 hrs to be followed by carbolization 2%
carbolic acidAlternatively 35 ml of 40% formalin in 10 gm
Pot. Permanganate for1000cft for 24 hrs
Sterilization of Instruments
• Autoclave• ETO• Flash Autoclave• Between Cases Autoclave• No chemical sterilization
Monitoring of Sterilization
• Use Chemical Indicators • On Outermost wrap• On inside wrap• Inside the tray• Microbiological indicators• Log book• Disposable instruments
Post operative infection
Discuss with patient and relativesExplain: - mechanics of infection - still treatable prognosis - patient cooperation - need for referralBatch number of all solutionsSamples for culture
Post op Infection
Document all findingsReview sterilizationGet peer reviewInform AIOS Legal cell/professional protection
Cluster Infection/Outbreak
Two or more infections at a timeRepeated infectionsInform DMO/DHSInfection control committee Inform AIOS /Legal CellSeek local legal helpPress briefing CMO/Medical committee
Conclusion
AIOS guidelines Legal validityCourt of Law
www.aios.in AIOS Guidelines soft copy:http://aios.org/endophguidelines2011.pdf
Thank you
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