Surgical Loupes Worn by Orthopaedic Surgeons Are a Reservoir for Microorganisms

A multinational survey characterizing the use of surgical magnifying loupes in dermatological surgery

BACKGROUND

The use of surgical loupes has not been well-documented in dermatological surgery.

OBJECTIVES

An online questionnaire was developed to characterize the use of loupes in dermatological surgery.

METHODS

The questionnaire was circulated to the memberships of the British Society of Dermatological Surgery, the European Society of Micrographic Surgery, and the Australasian College of Dermatologists. Responses were analyzed with a mixed methods approach using quantitative data analysis and inductive content analysis.

RESULTS

One-hundred twenty-five valid responses were received from 20 nations. Most respondents were from England (40%; 50/125), Australia (16%; 20/125), and the Netherlands (14.4%; 18/125). Overall, 71.2% (89/125) of respondents were consultants/Facharzt/attending. Furthermore, 55.2% (69/125) of respondents were Mohs surgeons. In dermatological surgery 38.4% (48/125) of respondents used surgical loupes routinely. The mode magnification level for loupes was 2.5× (67.5%; 27/40), with 3× second place (12.5%; 5/40). Exactly half (20/40) used through-the-lens style loupes and 40% (16/40) used flip-up-loupes. Inductive content analysis of the 51 free-text responses from nonloupe users uncovered several deterring factor themes, including expense (18/51), can manage without/don't need (14/51), and narrow field of view a(11/51), and uncomfortable/too heavy (9/51).

CONCLUSIONS

This is the first time the use of surgical loupes in dermatological surgery has been internationally characterized.

Comprehensive Compositional Analysis of the Slit Lamp Bacteriota

Slit lamps are routinely used to examine large numbers of patients every day due to high throughput. Previous, cultivation-based results suggested slit lamps to be contaminated with bacteria, mostly coagulase-negative staphylococci, followed by micrococci, bacilli, but also Staphylococcus aureus. Our study aimed at obtaining a much more comprehensive, cultivation-independent view of the slit lamp bacteriota and its hygienic relevance, as regularly touched surfaces usually represent fomites, particularly if used by different persons. We performed extensive 16S rRNA gene sequencing to analyse the bacteriota, of 46 slit lamps from two tertiary care centers at two sampling sites, respectively. 82 samples yielded enough sequences for downstream analyses and revealed contamination with bacteria of mostly human skin, mucosa and probably eye origin, predominantly cutibacteria, staphylococci and corynebacteria. The taxonomic assignment of 3369 ASVs (amplicon sequence variants) revealed 19 bacterial phyla and 468 genera across all samples. As antibiotic resistances are of major concern, we screened all samples for methicillin-resistant Staphylococcus aureus (MRSA) using qPCR, however, no signals above the detection limit were detected. Our study provides first comprehensive insight into the slit lamp microbiota. It underlines that slit lamps carry a highly diverse, skin-like bacterial microbiota and that thorough cleaning and disinfection after use is highly recommendable to prevent eye and skin infections.