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Ocular Infections: Prophylaxis and Management
Namrata Sharma, Neelima Aron, Atul Kumar
CHAPTER 1:
Introduction
HISTORY
CLEANING, DISINFECTION AND STERILIZATION
A Rational Approach
Definitions12,17,18
CLEANING12,19–21
Cleaning of Patient Care Items
STERILIZATION AND DISINFECTION
Sterilization Practices12
The Methods of Disinfection
The Ideal Disinfectant
Alcohols12,17,24–26
Chlorine and Chlorine Compounds12,17,27–32
Formaldehyde12,17,28,33–35
Glutaraldehyde12,17,36–39
Hydrogen Peroxide12,17,40–42
Iodophors12,17,43–45
Ortho-phthalaldehyde12,17,46–48
Peracetic Acid12,17,49–52
Peracetic Acid and Hydrogen Peroxide12,17,52,53
Phenolics12,17,54
Quaternary Ammonium Compounds12,17,55,56
Heavy Metals12,57–59
Ultraviolet Radiation12,22
CHAPTER 2:
Operation Theatre: Design and Layout
INTRODUCTION
HISTORY
SETTING UP AN OPERATION THEATRE
Design and Principles
LAYOUT
Operating Room
Doors
Walls and Ceiling (Fig. 2.7)
Floor
LIGHTING
TEMPERATURE AND HUMIDITY
SCRUB ROOM
RECOVERY ROOM
MINOR OPERATION THEATRE
CHAPTER 3:
Air Flow System in Ophthalmic Operation Theatre
INTRODUCTION
VENTILATION/AIR CONDITIONING
LAMINAR AIR FLOW
AIR CHANGE PER HOUR
AIR VELOCITY
POSITIVE PRESSURE
AIR FILTRATION
MAINTENANCE OF AIR FLOW SYSTEM
CHAPTER 4:
Water Requirement in Ophthalmic Operation Theatre
INTRODUCTION
HANDWASHING
INSTRUMENTS
Cleaning of Surgical Instruments
Corrosion and Rust
Autoclaving
Methods to Remove Impurities from Tap Water to Make of it Suitable for Use in an Autoclave6
Reverse Osmosis
Deionization
Distillation
Recommended Quality of Water
CHAPTER 5:
Operation Theatre List and Record Maintenance
THE OPERATION THEATRE LIST
RECOMMENDATIONS
SPECIAL CONSIDERATIONS WHILE PREPARING AN OPERATION THEATRE LIST
DISTRIBUTION OF THE OPERATION THEATRE LIST
RECORD MAINTENANCE IN OPERATION THEATRE
Operation Register
Daily Register
Sterilization Register
Temperature and Humidity Control Register
Microbiology Register
Water Analysis and Culture Register
Instrument Register
Biomedical Waste Management Register
Central Sterile Supply Department Register
Linen Stock Register
Complaints Register
CHAPTER 6:
Pre-operative Patient Preparation
INTRODUCTION
PRE-OPERATIVE MEASURES
OPERATION THEATRE ATTIRE
MARKING AND CLEANING OF THE SURGICAL AREA
SHIFTING THE PATIENT TO OPERATION THEATRE
SURGICAL PREPARATION
HIGH RISK: HIV, HBsAg, HCV
CONCLUSION
CHAPTER 7:
Pre-operative Preparation of Operation Theatre Personnel
OPERATION THEATRE OCCUPANCY
OPERATION THEATRE ATTIRE
COMPONENTS OF THE ATTIRE
Body Cover
Surgical Mask
Head Cover
Eye Protection Goggles
Room Shoe and Shoe Covers
Surgical Gowns
Surgical Gloves
SPECIAL CASES: HIV, HEPATITIS B AND C
Surgical Attire in Special Cases
Precautions to Prevent Transmission of Infection
SURGICAL SCRUBBING
Preparation of Scrubbing
Scrubbing Procedure
GOWNING AND GLOVING
Gowning
Gloving
Procedure
CHAPTER 8:
OT Protocol: Codes of Conduct
INTRODUCTION
GENERAL CONSIDERATIONS
SCRUBBED SURGEON AND ASSISTANT
NURSING STAFF
Opening Packages
Pouring Sterile Solution
OPERATION THEATRE ASSISTANT
OBSERVER IN THE OPERATION THEATRE
VISITORS IN THE OPERATION THEATRE
INTRA-OPERATIVE AND POST-OPERATIVE PRACTICES2
PRACTICES IN THE USE OF INTRA-OPERATIVE ADJUNCTS
Irrigating Solutions
Ophthalmic Viscoelastic Devices
Phacoemulsification Instruments
CHAPTER 9:
Operation Theatre Sterilization
OPERATION THEATRE CLEANING
OPERATION THEATRE DISINFECTION AND STERILIZATION
Chemical Disinfection
Fogging Method
Ultraviolet Rays
CLEANING SCHEDULE
Before Surgery
Between Operative Procedures
After Surgery
SEPTIC OPERATION THEATRE
Setup of Septic Operation Theatre
Sterilization of Septic Operation Theatre
SPECIAL CASES: HIV, HEPATITIS B, HEPATITIS C
Setup of Operation Theatre
CHAPTER 10:
Ophthalmic Instrument Sterilization
INSTRUMENT PROCESSING
Cleaning of Instruments
Packaging of Instruments
Loading
Storage
Handling
STERILIZATION
Heat
Steam Under Pressure/Moist Heat (Autoclave) (Fig. 10.6)
Considerations
Dry Heat (Hot Air Oven)
Flash Sterilization7
Ethylene Oxide Method8–11 (Fig. 10.7)
Principle
Time of Sterilization
Hydrogen Peroxide Gas Plasma Method14,15 (Fig. 10.8)
Principle
Time of Sterilization
Peracetic Acid Method14,16
Principle
Ionising Radiation17
Other Methods
Ozone18
Microwave8,19–21
Vaporized Hydrogen Peroxide22,23
Formaldehyde Steam24
Performic Acid
INSTRUMENT STERILIZATION IN OPHTHALMIC OT
CHAPTER 11:
Waste Disposal in Ophthalmic Operation Theatre
INTRODUCTION
CATEGORIZATION OF WASTE IN OPERATION THEATRE
SEGREGATION AND ACCUMULATION OF CATEGORIZED WASTE
PACKAGING OF SEGREGATED WASTES
TRANSPORTATION OF PACKED WASTES FROM OT TO FINAL SITE OF TREATMENT OR DISPOSAL
TREATMENT OF WASTE
TRAINING OF STAFF HANDLING WASTE DISPOSAL IN OPERATION THEATRE
CHAPTER 12:
Quality Control and Surveillance
INTRODUCTION
QUALITY CONTROL
Mechanical Indicators
Chemical Indicators
Types of Chemical Indicators
Biological Indicators
Continuous Quality Improvement
MICROBIOLOGICAL SAMPLING
Collection of Specimens from Surfaces and Inanimate Objects
Collection of Swab Specimens from Instruments
Air Sampling
Active Air Sampling20–25
Passive Air Sampling20–25
HOSPITAL STERILIZATION AND DISINFECTION POLICY
Choosing a Method of Sterilization1,26–30
Packaging1–4,31
Flash Sterilization1,4,8,32,33
Monitoring of Sterilizers1–16
Load Configuration4,34
Storage of Sterile Items1,3,4,34–37
Occupational Health and Exposure1,38,39
Quality Assurance1–4,33
CHAPTER 13:
Post-Cataract Surgery Endophthalmitis
MICROBIAL SPECTRUM OF POST-OPERATIVE ENDOPHTHALMITIS
MRSA AND MRSE: INCREASING RESISTANCE TO TOPICAL ANTIBIOTICS
RISK FACTORS AND INCIDENCE OF POST- CATARACT SURGERY ENDOPHTHALMITIS
Type of Cataract Surgery
Type and Location of Incision
Nature of Intraocular Lens
Surgical Complications
Patient-related Factors
PROPHYLAXIS OF POST-CATARACT SURGERY ENDOPHTHALMITIS
Pre-operative Period
Treating Pre-existing Ocular Conditions
Pre-operative Antisepsis: Preparing the Patient
Intra-operative Period
Post-operative Period
DIAGNOSIS AND MANAGEMENT
Dilemmas in the Prevention of Post-cataract Surgery Endophthalmitis
CONCLUSION
CHAPTER 14:
Post-Intravitreal Injection Infections
INTRODUCTION
INCIDENCE AND RISK FACTORS
CLINICAL PRESENTATION
DIAGNOSIS AND MANAGEMENT
PROPHYLAXIS
Pre-operative Patient Screening and Precautions
Drug Procurement or Preparation—Precautions for use of Drugs with Multi-Dose Vials
Prophylactic Topical Antibiotics
Patient Preparation
Sterilization of Operating Room and Operating Room Milieu
Intra-operative Precautions
Surgeon Factors
Peri-injection Precautions
Post-operative Precautions
CHAPTER 15:
Endophthalmitis after Pars Plana Vitrectomy
INTRODUCTION
CLINICAL FEATURES
RISK FACTORS
PROPHYLAXIS
MANAGEMENT
OUTCOMES
CHAPTER 16:
Post-LASIK Infections
INTRODUCTION
MICROBIAL SPECTRUM
RISK FACTORS
CLINICAL DIAGNOSIS
Confocal Microscopy: Role in Acanthamoeba and Fungal Keratitis
Polymerase Chain Reaction: Role in Viral, Fungal and Acanthamoeba Keratitis
PROPHYLAXIS
TREATMENT: MEDICAL AND SURGICAL THERAPY
CHAPTER 17:
Infections after Intrastromal Corneal Ring Segments
RISK FACTORS
ETIOLOGICAL ORGANISMS
PATHOGENESIS
DIFFERENTIAL DIAGNOSIS
CLINICAL FEATURES
General Symptoms
General Signs
MICROBIOLOGICAL WORK-UP
TREATMENT
Medical Therapy
Adjunctive Therapy
Surgical Therapy
COMPLICATIONS AND SEQUELAE
PROPHYLAXIS
CHAPTER 18:
Post-Collagen Cross-linking Infections
INCIDENCE
RISK FACTORS
Pre-operative Factors
Intra-operative Factors
Epithelial Defect
Prolonged Exposure to UV-A Radiation
Contaminated Solution
Post-operative Factors
Bandage Contact Lens
Use of Steroids
MICROBIAL PROFILE OF POST-COLLAGEN CROSS-LINKING INFECTION
PROPHYLAXIS
Pre-operative Period
Intra-operative Period
Post-operative Period
DIAGNOSIS AND MANAGEMENT
CHAPTER 19:
Post-Keratoplasty Infections
RISK FACTORS FOR GRAFT INFECTION AND PREVENTION
Donor-related Problems
Host-related Problems
Ocular Surface Disorders
Recurrence of Previous Infection
Topical Steroids
Use of Contact Lenses
Systemic Diseases
Socioeconomic Status
Graft-related Problems
Suture-related Problems
Persistent Epithelial Defect
Decompensated Graft
Wound Leak/Graft Dehiscence
History of Graft Rejection
Venting Incisions
CLINICAL FEATURES
INVESTIGATIONS
MICROBIOLOGICAL SPECTRUM
Bacteria
Fungi
Viruses
MANAGEMENT
Medical Management
Surgical Management
Treatment of Post-lamellar Keratoplasty Infections
PREVENTION
OUTCOMES
CHAPTER 20:
Bleb-Related Infections
INCIDENCE
CLASSIFICATION
RISK FACTORS
MICROBIAL SPECTRUM
PROPHYLAXIS
Pre-operative
Intra-operative
Post-operative
DIAGNOSIS AND MANAGEMENT
Management of Late Bleb Leak
VISUAL OUTCOME AND PROGNOSIS
PATIENT EDUCATION AND COUNSELING
CHAPTER 21:
Post-Strabismus Surgery Infections
INCIDENCE AND PREVALENCE
MICROBIAL FLORA AND RISK FACTORS
Glove Perforation
Intra-operative Contamination
ENDOPHTHALMITIS
ORBITAL AND PRESEPTAL CELLULITIS
SCLERITIS
SURGICALLY-INDUCED NECROTIZING SCLERITIS
PROPHYLAXIS AND MANAGEMENT
Prophylaxis
Surgeon Awareness
Avoiding Glove Perforation
Avoiding Suture and Needle Contamination
Endophthalmitis Prophylaxis
Periocular Infection Prophylaxis
Management
Suture Abscess
Preseptal Cellulitis
Orbital Cellulitis
Endophthalmitis
Scleritis and Surgically-induced Necrotizing Scleritis
CONCLUSION
CHAPTER 22:
Post-Pterygium Surgery Infections
INTRODUCTION
INCIDENCE AND MICROBIAL SPECTRUM
RISK FACTORS
PATHOGENESIS
CLINICAL PRESENTATION
INVESTIGATIONS
MANAGEMENT
PROPHYLAXIS4,5,20,23
CHAPTER 23:
Infections after Ocular Surface Reconstruction Surgery
INTRODUCTION
INCIDENCE
RISK FACTORS
Host Factors
Local Factors
Socioeconomic Status
Systemic Factors
Donor-related Factors
Intra-operative Factors
Post-operative Factors
CLINICAL FEATURES
Symptoms
Clinical Signs
INVESTIGATIONS
Conjunctival Swab
Corneal Scraping
Confocal Microscopy
Ultrasonography B Scan
Systemic Investigations
PROPHYLAXIS
Procurement and Storage of AMG
Improvement of the Ocular Surface
Role of the Operating Team
TREATMENT
Medical Management
Topical Medications
Supportive Therapy
Systemic Therapy
Monitoring
Surgical Management
Surgical Debridement
Tissue Adhesives and Corneal Transplantation
COEXISTING ENDOPHTHALMITIS
CHAPTER 24:
Infections after Oculoplasty Surgery
INTRODUCTION
PRE-OPERATIVE ASSESSMENT
INTRA-OPERATIVE PRECAUTIONS
POST-OPERATIVE CARE AND ANTIBIOTIC PROPHYLAXIS
MICROBIOLOGY PROFILE
ANTIBIOTICS FOR PROPHYLAXIS
DIAGNOSIS AND MANAGEMENT
INDEX
TOC
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