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OUTCOME OF AUDIT INTO CASES OF ENDOPHTHALMITIS

March 14, 2006 12:00 PM

An audit of clinical practice following three cases of endophthalmitis has found no single cause for these infections.

The audit was launched at the end of January when three patients developed the infection following eye surgery at the ACE Clinic in Glasgow.

Led by NHS Greater Glasgow's public health team, together with an external assessor from NHS Lanarkshire, the audit fully considered possible causes of the infection, from the clinic facilities to the actual operations themselves.

Overall, the clinic's practices were found to be of an acceptable standard. When assessed against best practice guidance on cataract surgery, however, some areas for improvement were identified to reduce further the risk of post-operative infection.

The investigation was led by Dr Syed Ahmed, Consultant in Public Medicine with NHS Greater Glasgow. He explained; "We conducted a thorough audit of the practices at the ACE Clinic to try to establish the source and circumstances of the infections.

"As with many retrospective investigations, no single cause for these infections was identified.This has often been the case when these rare, but known, complications have been investigated elsewhere.

"We also took the opportunity to assess the clinic's practices against the very latest best practice for cataract surgery. Our recommendations are intended to ensure that the clinic meets these highest standards."

The ACE Clinic has accepted all of the recommendations.As a consequence, NHS Greater Glasgow has now advised the clinic that they can resume surgery on patients.

ENDS

Notes to Editors

The key recommendations were as follows:

  • The clinic has no formal written protocol in place on how to manage

patients pre-operatively with superficial eye infections identified prior to cataract surgery.We have recommended that a written protocol be put in place identifying anyone with adverse risk factors from infection.

  • Antiseptic eye solutions given pre-operatively to patients are not single-use products.Instead the practice at the clinic is to make up enough separate solutions for more than one patient at a time.We have recommended that in future single use antiseptic products and drugs should be used. If single use solutions are not available they should be made up just before use.

  • There is no hand washing facility in the room used for pre-operative care and alcohol hand gel is used. We have recommended that alternative accommodation with adequate hand washing facilities should be used for pre-operative care.

  • There is currently a lack of standardisation in the use of antibiotics given to patients during surgery.This is due to a lack of evidence and agreement nationally between eye surgeons on whether such use of antibiotics is beneficial to patients.We have, however, recommended that the surgeons working at the clinic discuss, and aim to standardise, the use of antibiotics.

For further information contact 0141 201 4429.

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