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Published on: February 6, 2021
Residual debris as a potential cause of postphacoemulsification endophthalmitis
T Leslie1, D A Aitken, T Barrie
1Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK. thorfinnleslie@hotmail.com
Aim:
To examine residual debris within sterilised instruments prior to cataract surgery.
Methods:
(i) Flushings from 32 sets of phacoemulsification instruments, sterilised according to hospital routine protocols, were taken preoperatively and analysed by scanning electron microscopy (SEM). (ii) A total of 16 sets of flushings from a different institute were collected-with separation of samples collected from phacoemulsification and those from irrigation-aspiration (IA) instruments-and analysed in the same way. (iii) A total of 15 sets of flushings were collected from instruments where an automated flushing system was used prior to sterilisation.
Results:
(i)In the first study, 62% were clean, 16% were moderately contaminated and 22% were severely contaminated. Various contaminants were identified including lens capsule and cells, man-made fibres, squamous cells, bacteria, fungal elements, diatoms, red blood cells and proteinaceous material. (ii) In the second study, the results were similar and contamination of both phacoemulsification and IA instruments was shown. (iii) The third study showed that although a decrease in contamination followed automated flushing, contamination was not completely eliminated.
Conclusions:
Although all equipment had been sterilised, pyrogenic material was still present. These findings emphasise the importance of meticulous cleaning of all surgical equipment in which biological debris can remain.
Insights
Sterilised surgical instruments for cataract surgery often retain biological debris, including lens material and bacteria. Meticulous cleaning is crucial to prevent pyrogenic contamination, even after standard sterilization procedures.
Area of Science:
- Ophthalmology
- Microbiology
- Surgical Technology
Background:
- Sterilization protocols are critical for preventing surgical site infections.
- Residual debris on surgical instruments can pose a significant risk to patients.
- Cataract surgery requires highly specialized and meticulously cleaned instruments.
Purpose of the Study:
- To investigate the presence and types of residual debris on sterilized surgical instruments used in cataract surgery.
- To assess the effectiveness of routine sterilization protocols in eliminating contaminants.
- To evaluate the impact of automated flushing systems on instrument cleanliness.
Main Methods:
- Analysis of instrument flushings using scanning electron microscopy (SEM).
- Collection and analysis of samples from phacoemulsification and irrigation-aspiration (IA) instruments.
- Comparison of contamination levels before and after automated flushing procedures.
Main Results:
- A significant percentage of sterilized instruments (38%) showed moderate to severe contamination.
- Identified contaminants included biological material (lens capsule, cells, blood), fibers, and microorganisms.
- Automated flushing reduced contamination but did not eliminate it entirely.
Conclusions:
- Sterilization alone is insufficient to remove all pyrogenic materials from surgical instruments.
- Thorough manual cleaning is essential to ensure the removal of biological debris.
- Adherence to stringent cleaning protocols is vital for patient safety in ophthalmic surgery.
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