Friday, 30 October 2009

Nosocomial infection caused Nellore blindness: All about the hospital bane called pseudomonas

2009
By Syed Akbar
Hyderabad, Oct 27: It was not a wrong incision that caused infection leading to blindness at a mass surgical camp in Nellore. Health experts feel that there could have been inadequate sterilisation of the equipment used and indequate care exercised against infections during the operation.
According to Dr CR Sundaresan from Singapore, "perhaps since it was a camp setting, asepsis would not have been adequate". The improper follow up could also have contributed.
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About two dozen people, who underwent surgeries for cataract at a free camp organised by Bollineni Foundation in Nellore, were infected. Half a dozen of them turned blind. Improper disinfection is said to be the cause.
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Pseudomonas, which is blamed as the causative agent of infection in 16 of the people who underwent cataract surgery, is a highly dangerous organism that is capable of living even in antiseptic lotions. The doctors should have exercised utmost caution on the asepsis aspect, instead of just depending on the brand of the aseptic material used during the surgeries.
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Being Gram-negative bacteria, most Pseudomonas spp. are naturally resistant to penicillin and the majority of related beta-lactam antibiotics, but a number are sensitive to piperacillin, imipenem, tobramycin, or ciprofloxacin.This ability to thrive in harsh conditions is a result of their hardy cell wall that contains porins. Their resistance to most antibiotics is attributed to efflux pumps which pump out some antibiotics before they are able to act.
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Dr Sundaresan pointed out that Pseudomonas is the bane of hospital or medical procedure acquired infection (nosocomial infection). This notorious organism is hard to eliminate except with the most diligent measures, as it can even thrive in antiseptic lotions.
"Also a 'work up' before surgery is mandatory, which means that certain conditions such as diabetes mellitus, which could potentially cause this turn of events, must be excluded. Except for a single measurement of blood sugar, which in and of itself may not be an adequate measure to identify diabetes, a few investigations would have been performed," he argues.

Meanwhile, the Andhra Pradesh Opthalmological Society on Tuesday argued that the complication is not related to surgery "but to factors outside the control of the surgeon". According to Dr K Sivarama Krishna, association president, clustering or grouping of cases specially means some material or fulid used during surgery, such as irrigating fluid bottle, intraocular lens, viscoelastics, gloves etc were contaminated with bacteria.
"A surgeon uses these items of the brands he trusts, and it is not possible to check the sterility of each item before use. He has to trust the brand," he points out adding that this complication cannot be eliminated despite all efforts and "this risk has to be accepted as long as surgery happens. Otherwise surgery cannot happen".
The association said doctors had obtained consent of the patients for possible infection following eye surgery.

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