aios guidelines endoph new
DESCRIPTION
All India Ophthalmological Society issued guidelines for prevention and prophylaxis of the most devastating complication of intra ocular surgery , namely post operative infectious endophthalmitis .TRANSCRIPT
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AIOS Guidelines For Prevention of post Operative
Intraocular infections
Dr.NSD RajuTeam AIOS
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I have no financial interests or relationships to disclose
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Endophthalmitis
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Preoperative Measures
• Blood glucose level: less than 200 mg/dL
Systemic Blood Pressure: less than 150/90
mmHg
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External Eye Examination
• Meticulous external eye examination• Infection of adnexia• No routine syringing• No surgery - if regurgitation of pus
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Preop Measures
• Physicians clearance (Cardiac hepatic neurological Renal HIV Endocrine )
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Pre operative Measures
Topical antibiotics 4th generation fluoroqinolones 4 times 2
days prior to surgery
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Camp/Large Volume surgery
Usual precautions for SurgeryPhysicians clearance
Avoid Patients with high risk systemic problemsCombined surgery to be avoided
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Operative Measures
Pulse oximeter Anesthetist stand by Emergency Drugs Operating microscope
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Dedicated Ophthalmic O T
Lay out Outer zone- receptionClear zone- ChangingRoom transfer zoneAseptic zone
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The Surgeon and Assistant
Sterile gloves for every caseChange gown at least after 5 cases No street clothes in O R
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General Operative Measures
Staff with obvious infection not allowed Standard protocol for hand washing gowning Betadine/ Chlorhexidine Running water aqua guard No contact procedures tonometry biometryFresh Phaco tip for each caseNot more than 25 cases/session
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Pre operative Patient Preparation
Postpone surgery if congestion or discharge in the eyeO T dress for the patient with capBetadine 5% skin periorbital area and conjunctial sac 3 mtsDisposable drape isolate the lashes
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Post Operative
Patching optionalTopical anesthesia no patchingFollow up visit 1 3 7 and 30 daysSlit lamp evaluationProtective glasses 1 wkTopical antibiotics and steroid eye drops for minimum 4 weeks
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Documentations
Document all procedures and clinical findingsSurgeon available at the hospital for at least 1 w
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Important Considerations
• Max 5 personnel in O R per 180 sq ft• Fumigation -Sterility of OR thorough AldeKol -For 400 sq ft 325 ml sprayed for 30 mts - Close the OR for 2 hrs - switch on the AC for 2 hrs -Theatre ready in 3 hrs
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Fumigation
Three fumigations for the first timeRunning OT single fumigationProtocol: 30 ml of 40% formalin in 90 ml of clean water6 hrs to be followed by carbolization 2%
carbolic acidAlternatively 35 ml of 40% formalin in 10 gm
Pot. Permanganate for1000cft for 24 hrs
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Sterilization of Instruments
• Autoclave• ETO• Flash Autoclave• Between Cases Autoclave• No chemical sterilization
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Monitoring of Sterilization
• Use Chemical Indicators • On Outermost wrap• On inside wrap• Inside the tray• Microbiological indicators• Log book• Disposable instruments
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Post operative infection
Discuss with patient and relativesExplain: - mechanics of infection - still treatable prognosis - patient cooperation - need for referralBatch number of all solutionsSamples for culture
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Post op Infection
Document all findingsReview sterilizationGet peer reviewInform AIOS Legal cell/professional protection
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Cluster Infection/Outbreak
Two or more infections at a timeRepeated infectionsInform DMO/DHSInfection control committee Inform AIOS /Legal CellSeek local legal helpPress briefing CMO/Medical committee
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Conclusion
AIOS guidelines Legal validityCourt of Law
www.aios.in AIOS Guidelines soft copy:http://aios.org/endophguidelines2011.pdf
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Thank you