Reducing contamination when removing and storing corneas: a multidisciplinary, transversal, and environmental approach.
OBJECTIVE
The combination of a shortage of cornea grafts in France and a national average contamination rate of 9% to 10%, has led us to search for the origins of this contamination. The objective of our study was to reduce the number of unusable grafts resulting from contamination of corneas in organ culture.


METHODS
An external audit was carried out by an independent pharmacist on the removal conditions and treatment procedures for corneas. An environmental study was carried out, consisting of microbiological sampling of the corneas of donors who just died (<24 hours) as well as water and air samples in the premises used for removal. The Cornea Bank's procedures were submitted to a microbiological risk analysis using the "failure mode effects and criticity analysis" (FMECA) method.


RESULTS
The critical contamination periods were found to be before removal, during mortuary washing and during decontamination of the conjunctival cul-de-sac at the removal stage. The corrective measures taken have reduced contamination rates by half in 1 year.


CONCLUSIONS
Highlighting the sources of contamination has led to the implementation of effective targeted and low-cost measures that have allowed us to reduce significantly the number of cornea graft losses as a result of bacterial and fungal contamination.
Builles
Nicolas
N
Banque de Cornées des Hospices Civils de Lyon, Lyon, France.
Perraud
Michel
M
Reverdy
Marie-Elisabeth
ME
Burillon
Carole
C
Crova
Philippe
P
Brun
Frédéric
F
Chapuis
François
F
Damour
Odile
O
D003315:Cornea; D016039:Corneal Transplantation; D004340:Drug Contamination / Q000517:prevention & control*; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D009924:Organ Culture Techniques; D019188:Organ Preservation Solutions / Q000592:standards*; D012307:Risk Factors; D014019:Tissue Donors; D014021:Tissue Preservation / Q000379:methods*
D019188:Organ Preservation Solutions