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