New Concept of Infection Prevention
Journal of Nihon University Medical Association
Normal bacterial flora can be isolated from the conjunctiva in 60-98% of healthy adults. Normal conjunctival flora can be reduced to around 20% by using the conventional procedures of disinfecting the eyelid and ocular surface with povidone-iodine prior to surgery and physically washing the operative field with saline during surgery. Since bacteria on the ocular surface can gain entrance into the eye via instruments and other means, endophthalmitis occurs in 1 in 2,000 cases (0.05%) after
... ct surgery. Endophthalmitis is the most serious postoperative infection, and the visual outcome is often poor, even with appropriate treatments. Reports of experimental studies in the literature suggest that povidoneiodine concentrations ranging from 0.05 to 0.5% are highly bactericidal and non-toxic to eye tissues. From these basic scientific data, we proposed a method of "transient sterilization of the operative field" by repeated irrigation of the surgical field with 0.25% povidone-iodine during intraocular surgery. Our irrigation method combines the effect of physically washing off bacteria, as achieved with conventional saline washing, together with the bactericidal effect of povidone-iodine. We have used this method in a large number of intraocular surgeries, and have encountered no cases of endophthalmitis and no ocular complications, such as corneal injury. This simple and low-cost technique is also an infection prevention method that has no risk of inducing resistant bacteria.