A report of an outbreak of postoperative endophthalmitis.
We report an outbreak of endophthalmitis following cataract extraction or secondary intraocular lens (IOL) implantation in a 400-bed general hospital in northern Thailand. From December 1997 to September 1998, of 329 patients who had undergone cataract extraction or secondary IOL implantation in the hospital, 31 (9.4%) developed postoperative endophthalmitis. The interval between the operation and the clinical diagnosis of endophthalmitis ranged from 5 to 74 days with a median of 15 days. Of the 31 cases of endophthalmitis, 18 occurred in phacoemulsification (PE) with IOL, 11 in extracapsular cataract extraction (ECCE) with IOL, and 2 in secondary IOL implantation. Patients who had undergone PE with IOL had a significantly higher rate (12.4%) than those of ECCE with IOL (6.3%). The infection rates also increased with the order of the operations within each operation period (morning or afternoon); later operations were at higher risk. Our findings detected defects in sterilization for the surgeries including possible inadequacy in the autoclave sterilization of surgical instruments, insufficient exposure time with 2 per cent activated glutaraldehyde solution (about 15-30 minutes) for sterilizing some surgical instruments, and the use of multiple-dose intraocular irrigating solution. This outbreak of endophthalmitis emphasizes the necessity to monitor regularly the practice of sterilization/disinfection in hospitals for prevention and control of nosocomial infections.
Swaddiwudhipong
W
W
Department of Community and Social Medicine, Mae Sot General Hospital, Tak, Thailand.
Linlawan
P
P
Prasantong
R
R
Kitphati
R
R
Wongwatcharapaiboon
P
P
D002387:Cataract Extraction / Q000009:adverse effects* / Q000379:methods; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D009877:Endophthalmitis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D017053:Infection Control; D019654:Lens Implantation, Intraocular / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D013242:Sterilization; D013785:Thailand; D013997:Time Factors