Infection control audit and potential sources of infection of a Nigerian eye unit

The prevalence of post-surgical eye infections in Nigeria has not been documented. However, anecdotal reports suggest that post-operative endophthalmitis is fairly common in Lagos.

This study was done to investigate the sources of post-operative eye infections and the preparedness of the hospital to prevent such infections.

A bacteriological survey of all eye surgical procedures between September 2004 and June 2005 was performed. Relevant samples were cultured pre- intra and post operatively as required. In the eye clinic, and operation theatre, infection control procedures and practices were audited using a pre-designed questionnaire.

Out of 207 procedures performed, there was no case of post -operative eye infection but potential sources of infections identified included nares of staff, surgical packs, theatre bed, hands of surgeons and conjunctivae of patients. Running water and soap were available for hand washing. There was no specific provision for drying hands in the clinic and staff were observed to carry out hand wash considered ineffective. Staff showed good knowledge of disinfectants and antiseptic use. In the theatre, the staff who handle the steam sterilizer were not formally trained on its use. Although sterile packs were appropriately stored they were not dated. Appropriate types of waste bins were not in use and wastes were not segregated appropriately. Ophthalmic equipment were not adequately disinfected in between patients and use of eye drops for dilatation was communal.

Potential sources of post-operative eye infections were identified. Areas of deficiencies in infection control practices, which require proper infection control policies, include handwashing facilities and practices, sterilization procedures, disinfection of ophthalmic equipment, linen management and waste handling.