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Most surgeons do not follow CDC sterilization guidelines
SAN DIEGO, Calif. — The vast majority of ophthalmologists do not follow the instrument sterilization guidelines established by the Centers for Disease Control and Prevention, according to a surgeon speaking here.
Although it is difficult to unequivocally link sterilization procedures to infection outcomes, more than half the clinics tested grew fungi or bacteria on their equipment, David R. Hardten, MD, told attendees here at the American Society of Cataract and Refractive Surgery meeting.
Dr. Hardten and colleagues surveyed 34 clinics by questionnaire regarding their sterilization procedures, and they performed cultures on the immersion ultrasound equipment of those same clinics. They asked practitioners to follow their standard sterilization protocols, even though the practitioners were aware that their equipment would be tested for sterility.
Despite the possibility that some clinics had altered their normal sterilization protocols, the investigators found that only 14% had followed CDC guidelines. In addition, cultures taken from the probes, shells and tubing of the immersion ultrasound machines of more than half of the clinics (53%) grew organisms.
The questionnaires revealed that 44.1% of the clinics change the fluid in the machines after each patient, while 20.7% change it daily and 35.2% change it only when it runs out. Similarly, only 44.8% of the clinics change the tubing on the machines after each patient, 20.7% change it daily and 34.5% change it only when it wears out.
The survey also showed that 6.9% of the clinics use tap water rather than balanced salt solution during the sterilization process.
“If you follow these CDC guidelines with your equipment, you basically have negative cultures,” Dr. Hardten said.
Nevertheless, he added, “the clinical rates of infection would probably be much, much lower than the rates of positive cultures,” suggesting that it would be difficult to study whether sterilization habits affect the incidence of infection.