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Endophthalmitis prophylaxis using preoperative povidone iodine 5% audit

Poster Details

First Author: A.Hamroush UK

Co Author(s):    C. Morton              

Abstract Details



Purpose:

To review the pattern of preoperative prepping using povidone iodine 5%. Postoperative endophthalmitis is a devastating complication that can happen after intraocular surgery. Prophylaxis using povidone iodine has been shown in several studies to reduce the rate of postoperative endophthalmitis and decrease the bacterial flora on the conjunctival surface. Efficacy of povidone iodine 5% depends on pattern of use and contact time. European Society of Cataract and Refractive Surgeons recommends that povidone iodine should be allowed to act for a minimum of 3 minutes.

Setting:

Operating theatre in HM Stanley eye unit, Abergele Hospital, Abergele, Conwy, UK.

Methods:

Prospective audit of preoperative prepping using povidone iodine 5%. 66 patients underwent intraocular surgeries over 3 weeks at HM Stanley eye unit. All surgeries were done under local anaesthesia using subtenon injection of a mixture of Lignocaine and Hyaluronidase given by anaesthetist. Data collected included type of the operation, site, grade of surgeon, method of application of povidone iodine by the anaesthetist (eye lid, fornix or both), time between application of povidone iodine by the anaesthetist and start of the surgery in minutes, method of application of povidone iodine by the surgeon (eye lid, fornix or both), time between application of povidone iodine by the surgeon and first incision in minutes and seconds.

Results:

66 eyes of 66 patients were included in the audit, 35 Right and 31 Left. Surgeries were 54 phacos, 6 vitrectomies, 5 combined phaco-viscocanalostomy and 1 trabeculectomy. 41 operations were performed by consultants, 9 by trainees and 16 by staff grade doctors. Anaesthetists applied povidone iodine 5% to both eyelid and fornix of 55 patients, eyelid only in 11 patients and mean time between application and the start of the surgery was 13.4 minutes, median 13 minutes (5-30 minutes). Surgeons applied povidon iodine 5% to both eyelid and fornix in 6 patients, eyelid only in 60 patients and mean time between application and first incision was 200.15 seconds, median 198 seconds(92-408 seconds). Among the 66 patients included in the audit 6 patients had povidone iodine 5% applied to eyelid and fornix twice by anaesthetists and surgeons, 49 patients to eyelid twice and fornix once by anaesthetists and 11 patients to eyelid twice and none in the fornix.

Conclusions:

There is a need to improve the adherence to the appropriate method of preoperative use of povidone iodine 5%. Application on the eyelids only is not enough it has to be accompanied with application into the conjunctival fornix. It's also important to allow povidone iodine 5% the enough time to act. Lastly, the audit needs to be repeated after applying the mentioned changes. FINANCIAL INTEREST: NONE

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