Microbial safety implications of in-use topical diagnostic ophthalmic medications in eye clinics in Ghana

Food Safety in Sub-Sahara Africa, An insight into Ghana and Nigeria

Food safety is a global concern in today's world, and harnessing food safety in Sub-Saharan Africa, especially Nigeria and Ghana are momentous. This review presents an insight into the situation of food safety in Nigeria and Ghana. Using a desktop review technique, research papers were evaluated to find major sources of food safety concerns. It was revealed that many studies reported on food contamination at the consumption level whereas few reported on the healthiness of the production chain. Improper handling of food at the local markets, vending sites hygiene practices of food vendors, and bad transportation and packing systems have all been implicated. Inadequate education is a major cause of food contamination, especially at the consumption level. Again, etiologic agents responsible for food-borne illness in Ghana and Nigeria range from viruses, fungi, parasites, and protozoans to bacteria. They include rotavirus, hepatitis A virus, Lassa fever (LHF), human noroviruses (HNoV), Aspergillus parasiticus, Aspergillus flavus, Aspergillus niger, Taenia solium, Ascaris spp., Toxoplasma gondii, Cryptosporidium spp. Enterobacter spp., Pseudomonas spp., Campylobacter spp., Escherichia coli. Staphylococcus spp., Salmonella spp., Vibrio cholerae and Listeria monocytogenes. Their toxins are responsible for numerous food contaminants. Some foods are contaminated with chemicals including pesticide residues, lead, mercury, etc. Laws of food safety are not well enforced leading to complications in the food production chain. Rigorous monitoring and evaluation coupled with surveillance and education to harness the situation and detect issues that compromise the right process is a necessity. Finally, intentional enforcement of regulations by regulatory agencies will go a long way to curb food contamination and food-borne illnesses within the region.

Highlighting the Microbial Contamination of the Dropper Tip and Cap of In-Use Eye Drops, the Associated Contributory Factors, and the Risk of Infection: A Past-30-Years Literature Review

The sterility of eye drop content is a primary concern from manufacturing until opening, as well as during handling by end users, while microbial contamination of the dropper tip and cap are often disregarded. The contamination of these sites during drug administration represents a risk of microbial transmission and ocular infection. In this review, we aim to assess microbial contamination of the dropper tip and cap of in-use eye drops, the associated contributory factors, and the risk of infection. We conducted a literature search of the MEDLINE, PubMed, and Cochrane Central databases. A total of 31 out of 1503 studies were selected. All the studies conducted in different settings that documented microbiologically contaminated in-use eye drops were included. Our review showed that microbial contamination of the dropper tip and cap of in-use eye drops ranged from 7.7 to 100% of the total contaminated tested samples. Documented contributory factors were conflicting across the literature. Studies investigating the association between eye infection and microbial contamination of the dropper tip and cap were scarce. New technologies offer a promising potential for securing the long-term sterility of eye drop content, tips, and caps, which could benefit from more research and well-defined study protocols under real-life scenarios.

Clinical characteristics of external bacterial ocular and periocular infections and their antimicrobial treatment patterns among a Ghanaian ophthalmic population

Empirical antimicrobial therapy is linked to a surge in antimicrobial resistant infections. However, an insight on the bacteria etiology of ocular infections is essential in the appropriation of choice of antimicrobial among clinicians, yet there remains a dearth of data from Ghana. We investigated the bacteria etiology of external ocular and periocular infections and antimicrobial treatment patterns among a Ghanaian ophthalmic population. A multicenter study design with purposive sampling approach was employed. Patients demographics and clinical data were collated using a pretested structure questionnaire. Cornea specimens and conjunctival swabs were obtained for bacterial isolation following standard protocols. About 95% (98/103) of ocular samples were positive for bacteria culture. The proportion of Gram-negative bacteria was 58.2%, and the predominant bacteria species were Pseudomonas aeruginosa 38.8% and Staphylococcus aureus 27.6%. Conjunctivitis 40.0% and keratitis 75.0% were mostly caused by Pseudomonas aeruginosa. The routinely administered antimicrobial therapy were polymyxin B 41.2%, neomycin 35.1% and ciprofloxacin 31.6%. Participants demographic and clinical characteristics were unrelated with positive bacteria culture (p > 0.05). Our results showed a markedly high burden of ocular bacterial infections and variations in etiology. Bacterial infection-control and antimicrobial agent management programs should be urgently institutionalized to prevent the emergence of resistant infections.

Microbial contamination of multiple-dose preservative-free hospital ophthalmic preparations in a tertiary care hospital

Background

It is possible that preservative-free eye drops can be contaminated. The aim of this study was to assess the incidence of microbial contamination of preservative-free hospital-prepared anti-infective eye drops and investigate factors that contribute to contamination. This finding may help to raise awareness of this problem to medical healthcare staff and patients in order to prevent the transmission of microorganisms from eye drops to the patients through treatment of pre-existing eye diseases.

Methods

Two hundred and ninety-five eye drop bottles were collected from patients attending Rajavithi Hospital Ophthalmologic outpatient and inpatient department, including both those used by patients at home and those administered in the hospital by medical staff. Samples were taken from the tips of droppers and bottles, and the residual fluid inside the bottles was then cultivated onto different culture plates. The culture results were identified and analyzed according to various factors related to both individual users and the bottles.

Results

Seven different types of eye drops were collected and 71 (24.06%) of the 295 bottles were contaminated. Vancomycin eye drops were the most contaminated. Twenty-six different types of pathogens were identified, most frequently mold (42.98%), and the amount of contamination was higher in tips than in residual fluid inside the bottle. There was no statistically significant difference in contamination between patients used eye drops collected in outpatient units (32.14%) and medical staff used eye drops collected in inpatient settings (23.22%). The only factor that was statistically significant was the number of eye drops used per person. We found that samples from patients who used only up to 2 eye drops suffered contamination (42.8%) more than those from their counterparts who used at least 3 (22.18%), P ​= ​0.02.

Conclusions

Of these preservative-free hospital preparations anti-infective eye drops, 24.06% were contaminated. The number of eye drops used per person was statistically significant in triggering contamination. There is a possibility of number of eyedrops use person may trigger contamination.