Incidence of postoperative eye infections in a private eye hospital in Lagos, Nigeria.

BACKGROUND: There is a dearth of information on postoperative eye infections in Nigeria and most hospitals do not have an infection control program in place. OBJECTIVE: This study was done to investigate the incidence of post-operative eye infections, their potential sources and the preparedness of the hospital to prevent such infections. METHODS: A microbiological survey of all eye surgical procedures between March 2004 and May 2005 was performed. Relevant samples were taken and cultured pre, intra and post operatively as required. Definitions of infections were based on the Centers for Disease Control (CDC) Criteria. In the eye clinic, and operation theatre, infection control procedures and practices were audited using a pre-designed questionnaire. RESULTS: There were 2 cases of post operative eye infections (with Haemophilus influenzae and Corynebacterium species) during the one year of survey of 339 performed surgeries. S. aureus, Coagulase negative staphylococcus (CNS), and Enterobacter spp were cultured from the aqueous humour, as well as pre and post operative conjunctivae swabs of three other patients. Eighty four (24.8%) other patients were colonized post operatively with CNS (32), S. aureus (28), Klebsiella pneumoniae (8), E. coli (5), Corynebacterium species (3), Pseudomonas aeruginosa (1) Proteus mirabilis (4), Enterobacter species alone (1) and in association with CNS on 2 occasions. Seventy eight percent of patients had contact with staff who consistently haboured Staphylococcus species in their nares. Four patients (0.11%) were exposed to surgeons whose hands were contaminated and one eye (0.003%) to contaminated antiseptic solution. Facilities for hand washing and protective clothing were adequate but staffs were observed to perform an inadequate hands scrubbing. Most items were heat sterilized. Cleaning facilities were adequate and the environment was clean. The choice of antiseptic was correct, but that of disinfectant was considered incorrect. The ophthalmic equipments except the eye occluder were appropriately disinfected. Staffs were not protected when handling linen. Infected linens were separated from soiled linens only in the theatre. They were not bagged, and were hand sluiced. The only type of waste that was properly handled was sharps. All waste types were stored together prior to final disposal away from the public. CONCLUSION: The incidence of post-operative infection was 1.69% and their sources were the patients' normal flora. Other potential sources of post-operative eye infections identified included nares of hospital staff, hands of surgeon and hospital disinfectants. Areas of deficiencies in infection control practices, which require proper infection control policies, include hand scrubbing practices, disinfection, linen management and waste handling.

Infection control audit and potential sources of infection of a Nigerian eye unit.

BACKGROUND: The prevalence of post-surgical eye infections in Nigeria has not been documented. However, anecdotal reports suggest that post-operative endophthalmitis is fairly common in Lagos. OBJECTIVES: This study was done to investigate the sources of post-operative eye infections and the preparedness of the hospital to prevent such infections. METHODS: A bacteriological survey of all eye surgical procedures between September 2004 and June 2005 was performed. Relevant samples were cultured pre- intra and post operatively as required. In the eye clinic, and operation theatre, infection control procedures and practices were audited using a pre-designed questionnaire. RESULTS: Out of 207 procedures performed, there was no case of post -operative eye infection but potential sources of infections identified included nares of staff, surgical packs, theatre bed, hands of surgeons and conjunctivae of patients. Running water and soap were available for hand washing. There was no specific provision for drying hands in the clinic and staff were observed to carry out hand wash considered ineffective. Staff showed good knowledge of disinfectants and antiseptic use. In the theatre, the staff who handle the steam sterilizer were not formally trained on its use. Although sterile packs were appropriately stored they were not dated. Appropriate types of waste bins were not in use and wastes were not segregated appropriately. Ophthalmic equipment were not adequately disinfected in between patients and use of eye drops for dilatation was communal. CONCLUSION: Potential sources of post-operative eye infections were identified. Areas of deficiencies in infection control practices, which require proper infection control policies, include handwashing facilities and practices, sterilization procedures, disinfection of ophthalmic equipment, linen management and waste handling.