Post-op eye infections via salt solutions
Recent postoperative outbreaks of endophthalmitis call for heightened surveillance by ophthalmologists, hospital epidemiologists, and infection control practitioners for cases associated with invasive ocular operations, the Centers for Disease Control and Prevention in Atlanta advises.1
An infection of the ocular cavity, endophthalmitis can result in severe sequelae that includes blindness. Although most postoperative endophthalmitis following intraocular surgery is caused by infection with normal skin flora, cases associated with the intraoperative use of contaminated eye solutions have been reported in Thailand and Canada. The outbreaks were associated with the intraoperative use of intrinsically contaminated basal salt solution and hyaluronic acid.
Infection with gram-positive bacteria accounts for most such cases of endophthalmitis, suggesting that exposure usually occurs during surgery as the result of introduction of organisms from the patient's skin or ocular surface tissues. However, infection with the same microorganism in multiple patients can result from a common source, such as contaminated saline, lens, or lens solution. The two aforementioned outbreaks resulted from the intraoperative use of solutions believed to have been sterile.
The micro-organisms that caused the outbreaks -- Pseudomonas aeruginosa in Thailand and Bacillus species in Canada -- have rarely been implicated in cases of postoperative endophthalmitis. In the outbreak in Thailand, inadequate sterilization may have allowed contaminants to survive in the containers and solution.
In the outbreak in Canada, failure to maintain the commercially-prepared hyaluronic acid at the manufacturer's recommended storage temperature may have facilitated proliferation of microbial contaminants to achieve concentrations exceeding minimum infectious doses for the eye. In the United States, although the proportion of hospitals that produce their own ophthalmic solutions is unknown, most ophthalmic solutions used intraoperatively probably are commercially prepared. Although outbreaks of postoperative endophthalmitis caused by microorganisms present in intrinsically contaminated solutions occur infrequently, such outbreaks underscore the need for strict quality control by the producers of such solutions and strict adherence by the users of commercial products to product-storage procedures.
Reference
1. Centers for Disease Control and Prevention. Outbreaks of Postoperative Bacterial Endophthalmitis Caused by Intrinsically Contaminated Ophthalmic Solutions -- Thailand, 1992, and Canada, 1993. MMWR 1996; 45:491-494. *
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