evaluation of decontamination protocols for in-situ donor corneal retrieval in hospital mortuaries...

 Evaluation of Decontamination Protocols for In-Situ Donor Corneal Retrieval in Hospital Mortuaries

Radhika Tandon, MD, DNB, FRCSEd, FRCOphth

Prabhakar Singh, MBBS

J.S.Titiyal, MD;

Gita Satpathy, MD;

Niranjan Nayak, MD

Dr. Rajendra Prasad Centre for Ophthalmic Sciences

All India Institute of Medical Sciences, New Delhi.

The authors have no financial interests

ID NO. 16559

AIMS AND OBJECTIVES

• To evaluate the efficacy of povidone iodine alone vs the

adjunctive use of antibiotics for minimizing microbiological

load in donor cornea retrieved from hospital mortuaries.

• To study spectrum and sensitivity pattern of isolated micro-

organisms

MATERIALS & METHODS

Study design: Prospective randomized study.

Place of study: Dr. Rajendra Prasad Centre for Ophthalmic Sciences &

Mortuaries at All India Institute of Medical Sciences, New Delhi.

Study subjects: All donors between JUNE 2013 to NOV 2013 were screened.

Inclusion criteria: Eligible donor.

Donor’s family consent for eye donation.

Both the eyes suitable for donation.

Exclusion criteria: None.

MATERIALS & METHODS

All deceased potential donors handled by hospital mortuaries were screened.

Written consent from the legal next of kin for eye donation as well as for participating in study was obtained.

Under aseptic precaution eyelids and skin around the eyes were cleaned with povidone iodine (5%) soaked cotton swabs

Eyes were draped with surgical drape.

MATERIALS & METHODS

Speculum was inserted gently avoiding damage to corneal epithelium.

Cornea , conjunctival sac and fornices were irrigated with saline. Drops of 5% povidone iodine were instilled. Povidone iodine was washed off thoroughly

with saline after 3 mins .

Limbal swabs were taken and sent for microbial analysis.

Eyes were treated with 3 drops of 0.5% gatifloxacin eye drops in one and 0.5% chloramphenicol with 10000 IU of polymyxin-B eye drops in the other as per

the randomization treatment allocation.

MATERIALS & METHODS

Repeat limbal swabs were taken after 3 minutes and sent for microbial analysis.

In-situ harvesting of corneoscleral rims were performed & buttons were transferred in M.K. media.

Corneoscleral rims stored in M.K. media were transported in an insulated box with ice packs to eye bank for storage .

OUTCOME MEASURES

• Primary Outcome Measure :Percentage Decrease In Bacterial

Culture Positivity of donor eyes.

• Secondary Outcome Measure :Bacterial Spectrum And

Sensitivity Pattern of donor eyes.

RESULTS

0.0%

10.0%

20.0%

30.0%

40.0%33.10%

11.60%

21.4%

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%35.0%

33.70%

12.30%

18.8%

PERCENTAGE DECREASE IN BACTERIAL CULTURE POSITIVITY:

P value:0.0018 P value: 0.0005

RESULTS

17.50%19.00%20.50%

21.40%

18.80%

COMPARISON OF PERCENTAGE DECREASE IN BACTERIAL CULTURE POSITIVITY BETWEEN THE ANTIBIOTIC REGIMENS:

P VALUE: 0.683

There was no significant difference between the two antibiotic regimens in decreasing the microbiological load .

Organisms Frequency Sensitivity pattern

S.epidermidis 37 (11.7%) S 60 (19.4%)

Pseudomonas   23 (7.1%) S’ 14 (4.5%)

E. Coli 8 (2.5%) S’’ 12 (3.8%)

Diphtheroids  6 (1.9%) Total cultures sent 308 (100%)

Klebsiella  7 (2.2%)

Staph. aureus 2 (0.6%)

Enterococcus 1 (0.3%)

Strept. Viridans 4(1.2%)

Proteus  0 (0%)

Aceinatobacter  1 (0.3%)

Str. pneumoniae 2 (0.6%)

Total % positivity 91 (29.5%)

Total cultures sent 308 (100%)

S: Sensitive to all, S’: Resistant to all antibiotics  but sensitive to polymyxin-B, S’’: sensitive  to amikacin, gentamycin, tobramycin, polymyxin-B, chloramphenicol, cloxacillin, gatifloxacin, resistant to cefazolin, ceftriaxone

BACTERIAL SPECTRUM & SENSITIVITY PATTERN:

RESULTS

Resistance were seen more commonly among gram negative organisms like Pseudomonas, Klebsiella, E .Coli.

CONCLUSION

• Povidone iodine 5% alone does not eliminate microbiological load in donor corneas from hospital mortuaries. Subsequent application of adjunctive antimicrobial agents further significantly reduces the contamination frequency.

Corresponding author:Dr Radhika Tandon, MD, DNB, FRCSEd, FRCOphth Professor of Ophthalmology Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi-110029

E-mail address: radhikatandon@aiims.ac.in