Impact Of Ocular Care Training Of Nursing Staff On Incidence Of Ocular Surface Disorder Among Intensive Care Patients

 Ocular surface disorders pose a big challenge for ophthalmologists in an intensive care unit set up. Patients in an intensive care unit setup, are at an increased risk of developing Corneal abrasions, Infectious keratitis, corneal opacities & corneal perforations. This is due to mechanical ventilation, sedation, muscle relaxants, reduced  consciousness, reduced tear production, reduced blink rate & incomplete eye closure. Failure to recognize ocular problems till it reaches advanced stage by ICU staff, as the patient is suffering from acute life threatening conditions, can result in significant ocular morbidity. Though Ocular surface disorders are usually self-limiting, they may lead to visual impairment or blindness if extensive. 

Study Population: Patients admitted in Medical ICU 

Study duration: Time-bound study (approximately 5months.2months before the training of staff.one month for institution of eye care protocol after training of staff. 2months thereafter to study the impact of training.

Study Design: Prospective interventional study  

Sample Size: 200 patients (100 before training and 100 after training of nursing staff of medical ICU) 

Documentation of diagnosis of the patient, date of admission in hospital, duration of stay in ICU, whether ventilated or not, was done. Glasgow coma scale was noted. Eye examination with flouorescein staining  & Schirmers test was done.  Visual acuity in case of conscious was checked. Assessment on knowledge on ocular care among the nursing staff of medical ICU was done & graded as poor, average, good & excellent. The nursing staff of medical ICU were given training in the form of demonstration. After one month of institution of the protocol, the second phase of the study was done.  A comparison was made between pre training and post training change in ocular care knowledge of nursing staff  & incidence of ocular surface disorders

73 patients were on ventilator out of which 45 of patients were on ventilator with GCS less than 7. Among the ocular complaints, in 53 patients ocular complaints could not be elicited. Among those in whom the complaints could be elicited, redness was the most common complaint. Among the examination of eye discharge patients on ventilator had more eye discharge which was proportional to the degree of lagophthalmos. The eye discharge had significantly reduced by 2.5 times in the post training group. The corneal pathology in the post training group had reduced to 22. Of the 20 staff who were in charge of the ICU, 11(55%) had average knowledge on eye assessment. Post training 11 staff had excellent training on assessment of red eye. 

 ICU patients are more susceptible to develop dry eye, keratopathy, and ocular infections, they should be consulted by an ophthalmologist for early diagnosis of ocular surface disorders .Eye care is a very important part of nursing care in sedated and ventilated patients in the ICU. Our standard eye care in ICU patients must include ocular lubrication with artificial tear drops and ointments. Ophthalmic consultations are routinely needed in ICU subjects who are hospitalized for more than one week or if ICU staff suspects any eye problems. However, there is still no standard nursing eye care in ICUs and the practice varies greatly in terms of the frequency and method of eye care.