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Reusing surgical materials for cataract surgery: an assessment of potential contamination
Aakriti Garg Shukla1, David F Chang, Thamizhselvi Dhanaseelan
1From the Glaucoma Division, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York (Shukla); Department of Ophthalmology, University of California-San Francisco, San Francisco, California (Chang); Department of Cataract and Refractive Services, Aravind Eye Hospital, Pondicherry, India (Dhanaseelan, Vivekanandan); Department of Microbiology, Aravind Eye Hospital, Pondicherry, India (Gubert); Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan (Robin); Department of Ophthalmology and International Health, Johns Hopkins University, Baltimore, Maryland (Robin); Department of Glaucoma, Aravind Eye Hospital, Pondicherry, India (Venkatesh).
Purpose:
To evaluate microbiological cultures of cataract surgical devices and products that were reused for multiple cases.
Setting:
Aravind Eye Hospital, Pondicherry, Tamil Nadu, India.
Design:
Prospective cohort study.
Methods:
Samples from multiple surgical instruments and products that were reused for consecutive cataract surgeries underwent bacterial and fungal cultures and were monitored alongside positive controls for 7 days. This included instruments that were processed using immediate use steam sterilization (IUSS) between cases (eg, surgical cannulas, syringes, phacoemulsification and coaxial/bimanual irrigation/aspiration [I/A] tips, phacoemulsification and I/A sleeves) (Group 1), instruments that were used without sterilization between cases (eg, phacoemulsification tubing/handpieces, coaxial I/A handpieces) (Group 2), and the residual (unused) fluid from balanced salt solution bags after being used for multiple patients (Group 3).
Results:
3333 discrete samples were collected from all 3 product groups that were reused across multiple patients. In all collected samples, no bacterial or fungal growth was observed. Of the 3241 cataract surgeries that used reused and IUSS-sterilized instruments alongside instrument sets cultured on the same day and balanced salt solution bags shared across multiple patients, no eyes developed endophthalmitis over a 6-week follow-up period.
Conclusions:
Bacterial or fungal growth was not found in extensive microbiological cultures of IUSS-sterilized ophthalmic surgical instruments and cataract surgical products that were reused in multiple patients. This microbiological data complements clinical endophthalmitis data from 2 million consecutive cases at the Aravind Eye Hospital, suggesting that their instrument and surgical supply processing practices may allow for safe and sustainable ophthalmic care.
Insights
Microbiological cultures of reused cataract surgical devices showed no bacterial or fungal growth. This supports the safety and sustainability of ophthalmic care practices when instruments are properly processed.
Area of Science:
- Ophthalmology
- Microbiology
- Infection Control
Background:
- Cataract surgery involves numerous instruments and products.
- Reusable surgical items raise concerns about potential microbial contamination.
- Ensuring sterility of reused devices is crucial for patient safety.
Purpose of the Study:
- To microbiologically evaluate reused cataract surgical instruments and products.
- To assess the safety of immediate use steam sterilization (IUSS) for ophthalmic instruments.
- To determine the risk of microbial contamination in reused surgical supplies.
Main Methods:
- Prospective cohort study at Aravind Eye Hospital, India.
- Bacterial and fungal cultures performed on 3333 samples from reused instruments and balanced salt solution bags.
- Instruments were categorized based on reuse with or without IUSS between cases.
Main Results:
- No bacterial or fungal growth detected in any of the 3333 cultured samples.
- Zero cases of endophthalmitis observed in 3241 cataract surgeries utilizing reused instruments.
- No microbial contamination found in instruments processed with IUSS or in residual balanced salt solution.
Conclusions:
- Extensive microbiological cultures confirmed no microbial growth on reused, IUSS-sterilized ophthalmic surgical instruments.
- Findings suggest that current processing practices at Aravind Eye Hospital ensure safe and sustainable ophthalmic care.
- Microbiological data aligns with low endophthalmitis rates from millions of surgeries.
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