Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin

Lee P Schelonka,1 Margaret A SaBell2 1Department of Opthalmology, Kaiser Permanente Lone Tree Medical Offices, Lone Tree, 2Department of Infection Control, Kaiser Permanente Lone Tree Medical Offices, Lone Tree, Denver, CO, USA Purpose: This study aimed to determine whether switching from balanced...

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Autores principales:	Schelonka LP, SaBell MA
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/9a35a58cc4534be3a58175a033188d22
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spelling	oai:doaj.org-article:9a35a58cc4534be3a58175a033188d222021-12-02T09:01:59ZPostcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin1177-5483https://doaj.org/article/9a35a58cc4534be3a58175a033188d222015-07-01T00:00:00Zhttp://www.dovepress.com/postcataract-endophthalmitis-prophylaxis-using-irrigation-incision-hyd-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Lee P Schelonka,1 Margaret A SaBell2 1Department of Opthalmology, Kaiser Permanente Lone Tree Medical Offices, Lone Tree, 2Department of Infection Control, Kaiser Permanente Lone Tree Medical Offices, Lone Tree, Denver, CO, USA Purpose: This study aimed to determine whether switching from balanced salt solution (BSS) to vancomycin 20 g/mL BSS for incision hydration and eye pressurization reduces the rate of postcataract endophthalmitis.Methods: This was a patient safety/quality improvement project, including all patients undergoing cataract surgery at the Kaiser Permanente Colorado Ophthalmology Department from January 2002 to December 2014. Throughout the study, patients received vancomycin 20 µg/mL in the irrigating solution. During the baseline period from 2002 to 2005, surgeons pressurized eyes and hydrated incisions with plain BSS. During the intervention period from 2006 through 2014, surgeons switched from BSS to the vancomycin/BSS irrigating solution for eye pressurization and incision hydration.Results: A total of 57,263 cataract operations were performed by 24 surgeons at seven surgical centers: 12,400 in the baseline period and 44,863 in the intervention period. The rate of postcataract endophthalmitis declined significantly from 5/12,400 (rate: 0.4/1,000) in the baseline period to 1/44,863 (rate: 0.022/1,000) during the intervention period (odds ratio [OR]: 18.1, 95% confidence interval [CI]: 2.11–154.9; χ2=13.5, P=0.00024). Accounting for an estimated 2.05-fold risk reduction due to confounding variables, the risk reduction attributed to the intervention remained significant: (adjusted OR: 8.78, 95% CI: 1.73–44.5; χ2=10.06, P=0.0015). Since 2009, we have not experienced any cases of postcataract endophthalmitis after 32,753 operations.Conclusion: We experienced a significant reduction in postcataract endophthalmitis when we switched from BSS to the vancomycin/BSS irrigating solution for incision hydration and eye pressurization. The pharmacokinetics profile indicates that this switch was important for effective prophylaxis. Keywords: endophthalmitis, cataract surgery, vancomycin irrigation, quality improvementSchelonka LPSaBell MADove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2015, Iss default, Pp 1337-1345 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Schelonka LP SaBell MA Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin
description	Lee P Schelonka,1 Margaret A SaBell2 1Department of Opthalmology, Kaiser Permanente Lone Tree Medical Offices, Lone Tree, 2Department of Infection Control, Kaiser Permanente Lone Tree Medical Offices, Lone Tree, Denver, CO, USA Purpose: This study aimed to determine whether switching from balanced salt solution (BSS) to vancomycin 20 g/mL BSS for incision hydration and eye pressurization reduces the rate of postcataract endophthalmitis.Methods: This was a patient safety/quality improvement project, including all patients undergoing cataract surgery at the Kaiser Permanente Colorado Ophthalmology Department from January 2002 to December 2014. Throughout the study, patients received vancomycin 20 µg/mL in the irrigating solution. During the baseline period from 2002 to 2005, surgeons pressurized eyes and hydrated incisions with plain BSS. During the intervention period from 2006 through 2014, surgeons switched from BSS to the vancomycin/BSS irrigating solution for eye pressurization and incision hydration.Results: A total of 57,263 cataract operations were performed by 24 surgeons at seven surgical centers: 12,400 in the baseline period and 44,863 in the intervention period. The rate of postcataract endophthalmitis declined significantly from 5/12,400 (rate: 0.4/1,000) in the baseline period to 1/44,863 (rate: 0.022/1,000) during the intervention period (odds ratio [OR]: 18.1, 95% confidence interval [CI]: 2.11–154.9; χ2=13.5, P=0.00024). Accounting for an estimated 2.05-fold risk reduction due to confounding variables, the risk reduction attributed to the intervention remained significant: (adjusted OR: 8.78, 95% CI: 1.73–44.5; χ2=10.06, P=0.0015). Since 2009, we have not experienced any cases of postcataract endophthalmitis after 32,753 operations.Conclusion: We experienced a significant reduction in postcataract endophthalmitis when we switched from BSS to the vancomycin/BSS irrigating solution for incision hydration and eye pressurization. The pharmacokinetics profile indicates that this switch was important for effective prophylaxis. Keywords: endophthalmitis, cataract surgery, vancomycin irrigation, quality improvement
format	article
author	Schelonka LP SaBell MA
author_facet	Schelonka LP SaBell MA
author_sort	Schelonka LP
title	Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin
title_short	Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin
title_full	Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin
title_fullStr	Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin
title_full_unstemmed	Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin
title_sort	postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/9a35a58cc4534be3a58175a033188d22
work_keys_str_mv	AT schelonkalp postcataractendophthalmitisprophylaxisusingirrigationincisionhydrationandeyepressurizationwithvancomycin AT sabellma postcataractendophthalmitisprophylaxisusingirrigationincisionhydrationandeyepressurizationwithvancomycin
_version_	1718398260073201664

Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin

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