what happens? endophthalmitis post operative stop it no
TRANSCRIPT
![Page 1: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/1.jpg)
WELCOME
SYMPOSIUM OF
BSCRS
![Page 2: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/2.jpg)
What happens?
ENDOPHTHALMITIS
POST OPERATIVE
![Page 3: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/3.jpg)
STOP ITNO
![Page 4: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/4.jpg)
DIAGNOSIS &PROPHYLAXIS OF
POST OPERATIVE ENDOPHTHALMITIS
Prof.A.S.M.Kamal Uddin
![Page 5: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/5.jpg)
DIAGNOSIS
•Clinical examination•Conj.swab•AC tap/Vit tap
![Page 6: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/6.jpg)
ESCRS meta analysis
CNS (coagulase-negative staphylococci)
33 - 77 %
BHS (ß-haemolytic streptococci), S. pneumoniae, ∂-haemolytic streptococci including S. mitis and S. salivarius
9 - 19 %
Staphylococcus aureus 10 - 21 %
Gram-negative bacteria including Ps. aeruginosa (occurs rarely)
6 - 22 %
(Candida sp., Aspergillus sp., Fusarium sp.)
8 %
![Page 7: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/7.jpg)
SUMMARY
29%- 43% intraocular contamination occurs with facultative pathogenic bacteria Sherwood, D. R., Rich, W. J., Jacobs, J. S., Hart, R. J., Fairchild, Y. L.: Bacterial
contamination of intraocular and extraocularfluids during extracapsular cataract extraction. Eye 3, 1989, 308 - 312
Only 0.3-0.015% Post operative endophthalmitis
Significant % of apparent endoph cases Culture -VE
![Page 8: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/8.jpg)
SUMMARY
75%-95% of reported cases Gm +ve Ophthalmology 1999;106:1869-77
Causative organisms after cataract Sx-Usually genetically Identical to Pt’s own floraArch Ophthalmol1997; 115:357-361
8% Fungus
![Page 9: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/9.jpg)
BANGLADESH (IIEH)
Organism 2012No organism 140Gm +ve cocci 02Gm+ve bacilli 19fungus 15Total 180
![Page 10: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/10.jpg)
ENDOPHTHALMITIS
HOST RESISTANC
E
MICROBIAL POPULATION
VIRULANCE
29 – 43%
0.3-.015%
![Page 11: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/11.jpg)
INCIDENCES ( phaco era) escrs 2007
![Page 12: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/12.jpg)
PE SCENARIO ESCRS meta analysis
1910 10.001970- 1990 0.12 (Europe)
0.072 (USA)2000 - 0.3 – 0.015
![Page 13: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/13.jpg)
INCIDENCES (BANGLADESH)Month 2011 2012 2013January 17 3 39February 4 1 13March 3 1 18April 1 1 25May 5 0 27June 0 0 13July 4 0 28August 1 10 September 1 20 October 17 48 November 22 68 December 13 39 88 191 155
![Page 14: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/14.jpg)
RISK FACTORSSwedish National Cataract Register collected from 2002-2004 & 2005-2010
History 2002 -2004
2005-2010
Patient age (yrs)0–84 _>85
76/187 797 (0.040%)32/37 673 (0.085%)
104/393 298 (0.026)31/71 483 (0.043)
Type of surgeryPhaco with IOLOther than phaco with IOL†
101/220 658 (0.046%)6/4107 (0.146%)
128/459 640 (0.028)7/5221 (0.13)
Incision typeSclerocorneal Clear corneal
27/74 087 (0.036%)80/151 182 (0.053%)
Intracameral cefuroximeGiven Not given
100/223 156 (0.045%)8/2315 (0.350%)
123/461 951 (0.027)11/2804 (0.39)
Communication with vitreousAbsent Present
93/219 655 (0.042%)14/5790 (0.242%)
127/456 973 (0.028)8/7888 (0.1)
![Page 15: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/15.jpg)
RISK FACTORS
Older age of patientPreoperative topical antibioticsPovidone IodineMore time more manipulationVitreous face breakdownPhaco vs SICSCCI vs scleral incision Intra cameral injectionSubconj inj. Of Antibiotics.
![Page 16: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/16.jpg)
FLOW CHART – PROPHYLAXIS GUIDELINES(Based on the results of ESCRS multi-centre study as well as Healy et al.)
1• Topical
antibiotics 24 or 48 hours prior to surgery
2• Apply topical
antibiotic 1 hour and half-hour prior to surgery
3• Povidone iodine
minimum of three minutes
![Page 17: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/17.jpg)
4• Apply 10 per cent
povidone iodine to the peri-orbital area
5 • Surgeon washes hands properly
6 • Gloves and gowning properly
![Page 18: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/18.jpg)
7• Apply surgical drapes
properly
8• Perform
phacoemulsification surgery.
• Use foldable IOLs with sterile injector
9 •Apply inj cefuroxime (0.9 per cent) by intra-cameral injection at the end of surgery.
![Page 19: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/19.jpg)
10• Antibiotics in the
irrigation fluid not encouraged
11• Re-apply topical
antibiotics at the end of surgery
12
• Use of subconjunctival antibiotic is not thought to offer effective prophylaxis
![Page 20: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/20.jpg)
PITFALLS
OR protocolPatient relatedOT personal related OT assistant
![Page 21: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/21.jpg)
OR PROTOCOL
operating room (OR) layout and disinfection
sterile surgical protocolsterilisation of instruments
![Page 22: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/22.jpg)
Operating Room (OR) Layout and Disinfection Protocol
a)The outer zone b)The clean zone c)The aseptic
zone d)The disposal
zone
![Page 23: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/23.jpg)
Ventilation
The current United States Public Health Service minimum requirements:
Temperature between 18-24°C, Humidity 55-80%, and 25
changes per hourBacterial count of air should not
exceed l/ft3(35.5/m3).
![Page 24: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/24.jpg)
STERILE SURGICAL PROTOCOL
Air flow /AC ,Fan OT sterilization Oversrowding
![Page 25: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/25.jpg)
STERILE SURGICAL INSTRUMENTS
![Page 26: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/26.jpg)
PATIENT RELATED
• Select appropriate pt.
• Antibiotics prophylaxis
• Proper cleaning• Povidone iodine
![Page 27: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/27.jpg)
OT PERSONAL
•Cap masking
![Page 28: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/28.jpg)
GowningGloving
![Page 29: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/29.jpg)
OT ASSISTANT
Disposables undraping
![Page 30: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/30.jpg)
OT ASSISTANT
Fluid soaked trolly
![Page 31: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/31.jpg)
OT ASSISTANT
Draping
![Page 32: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/32.jpg)
MODE OF INCIDENCE
ClusterEndemi
c Isolated
Weakness of the
protocol
Disposables (liquid)
Sterilization failure
![Page 33: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/33.jpg)
INCIDENCES (BANGLADESH)Month 2011 2012 2013January 17 3 39February 4 1 13March 3 1 18April 1 1 25May 5 0 27June 0 0 13July 4 0 28August 1 10 September 1 20 October 17 48 November 22 68 December 13 39 88 191 155
![Page 34: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/34.jpg)
WHAT BSCRS CAN DO?
Task force – to trace out evidence
Information – through SMS/website etc
Microbial study of each lot of disposables
ETO sterilization plantEndophthalmitis study
![Page 35: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/35.jpg)
![Page 36: What happens? ENDOPHTHALMITIS POST OPERATIVE STOP IT NO](https://reader030.vdocuments.site/reader030/viewer/2022032702/56649cef5503460f949bceff/html5/thumbnails/36.jpg)
THANK YOU
দু�শ্চি�ন্তা�হী�ন মু�ক্ত জী�বন