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WELCOME

WELCOME. SYMPOSIUM OF BSCRS. What happens?. POST OPERATIVE. ENDOPHTHALMITIS. STOP IT. NO. Prof.A.S.M.Kamal Uddin. DIAGNOSIS &PROPHYLAXIS OF POST OPERATIVE ENDOPHTHALMITIS. DIAGNOSIS. Clinical examination Conj.swab AC tap/ Vit tap. ESCRS meta analysis. SUMMARY.

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WELCOME

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  1. WELCOME SYMPOSIUM OF BSCRS

  2. What happens? POST OPERATIVE ENDOPHTHALMITIS

  3. STOP IT NO

  4. Prof.A.S.M.KamalUddin DIAGNOSIS &PROPHYLAXIS OF POST OPERATIVE ENDOPHTHALMITIS

  5. DIAGNOSIS Clinical examination Conj.swab AC tap/Vit tap

  6. ESCRS meta analysis

  7. SUMMARY • 29%- 43% intraocular contamination occurs with facultative pathogenic bacteria Sherwood, D. R., Rich, W. J., Jacobs, J. S., Hart, R. J., Fairchild, Y. L.: Bacterial contamination of intraocular and extraocularfluids during extracapsular cataract extraction. Eye 3, 1989, 308 - 312 • Only 0.3-0.015% Post operative endophthalmitis • Significant % of apparent endoph cases Culture -VE

  8. SUMMARY • 75%-95% of reported cases Gm +veOphthalmology 1999;106:1869-77 • Causative organisms after cataract Sx-Usually genetically Identical to Pt’s own flora Arch Ophthalmol1997; 115:357-361 • 8% Fungus

  9. BANGLADESH (IIEH)

  10. ENDOPHTHALMITIS 29 – 43% 0.3-.015%

  11. INCIDENCES ( phaco era) escrs 2007

  12. PE SCENARIO ESCRS meta analysis

  13. INCIDENCES (BANGLADESH)

  14. RISK FACTORSSwedish National Cataract Register collected from 2002-2004 & 2005-2010

  15. RISK FACTORS • Older age of patient • Preoperative topical antibiotics • Povidone Iodine • More time more manipulation • Vitreous face breakdown • Phacovs SICS • CCI vsscleral incision • Intra cameral injection • Subconj inj. Of Antibiotics.

  16. FLOW CHART – PROPHYLAXIS GUIDELINES(Based on the results of ESCRS multi-centre study as well as Healy et al.)

  17. PITFALLS • OR protocol • Patient related • OT personal related • OT assistant

  18. OR PROTOCOL • operating room (OR) layout and disinfection • sterile surgical protocol • sterilisation of instruments

  19. Operating Room (OR) Layout and Disinfection Protocol • a)The outer zone • b)The clean zone • c)The aseptic zone • d)The disposal zone

  20. Ventilation The current United States Public Health Service minimum requirements: • Temperature between 18-24°C, • Humidity 55-80%, and 25 changes per hour • Bacterial count of air should not exceed l/ft3(35.5/m3).

  21. STERILE SURGICAL PROTOCOL • Air flow /AC ,Fan • OT sterilization • Oversrowding

  22. STERILE SURGICAL INSTRUMENTS

  23. PATIENT RELATED • Select appropriate pt. • Antibiotics prophylaxis • Proper cleaning • Povidone iodine

  24. OT PERSONAL • Cap masking

  25. Gowning • Gloving

  26. OT ASSISTANT • Disposables undraping

  27. OT ASSISTANT • Fluid soaked trolly

  28. OT ASSISTANT • Draping

  29. MODE OF INCIDENCE Isolated Endemic Cluster Weakness of the protocol Disposables (liquid) Sterilization failure

  30. INCIDENCES (BANGLADESH)

  31. WHAT BSCRS CAN DO? • Task force – to trace out evidence • Information – through SMS/website etc • Microbial study of each lot of disposables • ETO sterilization plant • Endophthalmitis study

  32. THANK YOU দুশ্চিন্তাহীন মুক্ত জীবন

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