Modified hygiene protocol maintains sterility at a high-volume cataract practice

J Cataract Refract Surg. 2009;35:629-636.

Adherence to a strict sterility protocol does not have to inhibit a high-volume cataract practice, even in a population at high risk of nosocomial infection.

According to a retrospective observational review of records at a surgical center performing about 100 intraocular surgeries a day in Pondicherry, India, a sterilization and asepsis protocol that had been implemented at the facility kept endophthalmitis rates low — about 0.09%, which is comparable to rates reported in developed countries.

Out of 42,426 cases reviewed for the study, 38 cases of presumed postoperative endophthalmitis were identified. Of the 38 cases, 35 occurred in patients who underwent extracapsular cataract extraction. Incidence of postoperative endophthalmitis among patients undergoing phacoemulsification was 0.02%.

According to the study, the low numbers occurred even though the population came from a poor rural area, most patients had advanced cataracts requiring larger incision surgeries and a significant number of cases were performed by ophthalmologists engaged in surgical training — all risk factors for postsurgical infectious complications.

The hygiene protocol used in the study included high-heat sterilization of instruments and linens the day before surgery; cleaning the eyelid and periocular skin with povidone-iodine 10% three times — once on the day before surgery, prior to entering the operating room and again while on the operating table; topical ciprofloxacin 0.3% drops administered the day before and the day of surgery; use of a sterilized instrument tray; and use of one drop each of povidone-iodine and topical homatropine before a bandage was applied.

According to the study, measures were also taken to maintain speed and efficiency in the operating room while also ensuring sterility, including reliance on short-cycle steam sterilization of instruments between cases, having surgical staff rinse gloves between surgeries, and not changing gloves or gowns until 10 surgeries were performed.