Disinfection of eyelid specula with chlorhexidine gluconate (Hibiclens) after examinations for retinopathy of prematurity.
BACKGROUND
The preferred method of cleaning eyelid specula between examinations for retinopathy of prematurity is unknown. A previous study showed that disinfection with 70% isopropyl alcohol swabs fails to eliminate viruses and bacteria from the specula.


OBJECTIVE
To determine if alternative sterilization procedures would allow multiple use of a single speculum without risking nosocomial infection.


METHODS
In phase 1, 40 autoclave-sterilized eyelid specula were randomized into either "cleaned" or "patient control" groups after being used for routine retinopathy of prematurity examinations performed in the outpatient setting. Specula in the cleaned group were cleaned with chlorhexidine gluconate (Hibiclens). Specula in the patient control group were not cleaned after use. All study specula were placed into enriched culture media from which bacterial and fungal cultures were obtained. In phase 2, 20 autoclave-sterilized eyelid specula were inoculated with a clinically relevant dilution of adenovirus serovar 5 or herpes simplex type 2. Specula were randomized into either a cleaned or a control group, and cell cultures and immunofluorescence assays were used to document and confirm, respectively, viral growth.


RESULTS
In phase 1, all 20 cultures from the patient control group grew bacteria compared with 0 (0%) of 20 cultures from the cleaned group and 0 (0%) of 5 from the cleaned control group. No fungi were isolated from any group. In phase 2, all 10 cultures from specula inoculated with adenovirus serovar 5 grew virus. None of the cultures from the 5 cleaned specula inoculated with herpes simplex type 2 grew virus. In contrast, all 5 cultures in the control group were positive for growth of herpes simplex type 2.


CONCLUSIONS
Autoclave sterilization is the ideal method of sterilization of eyelid specula between neonate examinations. When an alternative disinfection technique is required, washing the speculum with chlorhexidine gluconate and tap water is preferred over wiping with a 70% isopropyl alcohol swab. Arch Ophthalmol. 2000;118:786-789
Hutchinson
A K
AK
Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, 167 Ashley Ave, Charleston, SC 29425-2236, USA. hutchiak@musc.edu
Coats
D K
DK
Langdale
L M
LM
Steed
L L
LL
Demmler
G
G
Saunders
R A
RA
D000260:Adenoviruses, Human / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000494:pharmacology; D004203:Disinfection / Q000379:methods*; D005143:Eyelids; D018258:Herpesvirus 2, Human / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D006801:Humans; D007231:Infant, Newborn; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation*; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D013242:Sterilization / Q000379:methods; D013525:Surgical Instruments / Q000382:microbiology
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; C010882:chlorhexidine gluconate; D002710:Chlorhexidine