Outbreak of postoperative endophthalmitis caused by Pseudomonas aeruginosa: a case report and brief literature review

Infection prevention and control factors associated with post-cataract surgery endophthalmitis - a review of the literature from 2010 - 2023

Patients undergoing cataract surgery are at risk of post-cataract surgery endophthalmitis (PCSE), a sight-threatening complication. Cataract surgery is a relatively straightforward and quick procedure often performed under local anaesthetic. It is therefore simple to scale up to reduce the currently long waiting times, but it is important to maintain patient safety when considering high throughput surgery. This literature review aimed to identify appropriate infection prevention and control (IPC) measures to support increased throughput of cataract surgery in Scotland. Database searches were conducted using Medline and Embase from 2010 to 2023. Further hand-searching was also performed. The organisms associated with PCSE and IPC factors relevant to PCSE were analyzed. A range of microorganisms was associated with PCSE, where outbreak reports were most associated with Gram-negative bacteria and fungi, whereas retrospective chart reviews were most associated with Gram-positive bacteria. IPC risk factors identified were related to the built environment and issues with sterilization. Specifically, the sources of outbreaks included failures in the ventilation system, as well as contaminated ophthalmic solutions, surgical instruments, and medications. The factors identified in this review should be considered when implementing high throughput cataract surgery to ensure that patient safety is maintained.

Construction of a postoperative infection outbreak investigation form: A tool for early detection and control measures

BACKGROUND

To develop an investigation form for postoperative infection outbreak (PIO), and to identify sources of the outbreak in the early stage.

METHODS

After an exhaustive literature review, we used the Delphi method to determine the indicators and relative risk scores of the assessment tools through 2 rounds of specialist consultation and overall consideration of the opinions and suggestions of 20 specialists.

RESULTS

A total of 203 studies of PIO were eligible for inclusion. The mean authority coefficient (Cr) was 0.87. Kendall's W coefficient of the specialist consultation was 0.704 after 2 rounds of consultation (P < .005), suggesting that the specialists had similar opinions. Based on 4 primary items and 19 secondary items of the source of PIO, and tripartite distribution characteristics of infected patients, we constructed the PIO investigation form.

CONCLUSIONS

The PIO investigation form can be used in the investigation of the early-stage cluster of cases, it's a prerequisite for taking effective control measures, avoiding PIO occurrence. However, the effect of the investigation form needs to be further evaluated.

Optical illusions: The vital importance of instructions for use and intentionally approaching eye device processing

BACKGROUND

The purpose of this process and quality improvement activity was to address opportunities identified with cleaning, disinfection, and sterilization requirements for eye devices, and implement a robust and sustainable processing system to support safe patient care.

METHODS

Through the lean 6 Sigma methodology, the evaluation of noncritical, semicritical and critical device processing was conducted. A hierarchal approach to law, regulation, manufacturer's instructions for use, evidence-based guidelines, consensus documents, facility risk assessments, policy, and procedure was conducted. Over 15 diverse clinical areas within a large health care network were assessed for utilization of ophthalmic and optometric devices, with the review of inventory for manufacturer-instructed cleaning, disinfection and sterilization compliance.

RESULTS

An interdepartmental multidisciplinary team with oversight of over 10 service lines led the implementation of point-of-use treatment, transport, high-level disinfection, sterilization, storage, and documentation based on intended use.

CONCLUSIONS

During this experience, infection Preventionists performed a vital role in supporting a highly reliable cleaning, disinfection, and sterilization process. This undertaking required a team approach to apply instructions for uses and evidence-based practice that promoted sustainability and ultimately led to supporting the prevention of health care-associated infections and patient harm.

Extensively drug-resistant Pseudomonas aeruginosa panophthalmitis from contaminated artificial tears

Pseudomonas aeruginosa is one of the common gram-negative organisms that cause severe invasive infections in different organ systems. P. aeruginosa has unique intrinsic mechanisms to develop antimicrobial resistance quickly, making it extremely difficult to treat. We report a case of extensively drug-resistant (XDR) P. aeruginosa panophthalmitis due to contaminated artificial tears. This report investigates the role of systemic and intravitreal antimicrobials, summarizes the resistance mechanisms of P. aeruginosa, and provides an overview on cefiderocol, a novel antimicrobial that targets multidrug-resistant (MDR) and XDR Gram-negative pathogens.