Tuesday, 27 October 2009

Blinding at an eye camp: Inadequate sterilisation of equipment caused infection

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.

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.

Dr Sundaresan pointed out that Pseudonomas 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. Othersise surgery cannot happen".

The association said doctors had obtained consent of the patients for possible infection following eye surgery.

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Syed Akbar in an island in river Godavari with Papikonda hills in the background

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Syed Akbar at the 11th Conference of Parties to the United Nations Convention on Biological Diversity