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.)

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

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

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

23. 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).

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

25. STERILE SURGICAL INSTRUMENTS

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

27. OT PERSONAL • Cap masking

28. Gowning • Gloving

29. OT ASSISTANT • Disposables undraping

30. OT ASSISTANT • Fluid soaked trolly

31. OT ASSISTANT • Draping

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

33. INCIDENCES (BANGLADESH)

34. 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

36. THANK YOU দুশ্চিন্তাহীন মুক্ত জীবন