Automated surgical equipment requires routine disinfection of vacuum control manifold to prevent postoperative endophthalmitis1
Section snippets
Materials and methods
In the summer of 1997, we prospectively investigated a total of 37 aspiration bags from routine and uneventful vitrectomies and cataract operations performed by five different surgeons. In parallel, we searched for possible mechanisms of contamination of the aspiration fluid. After the source of contamination was tracked down to the internal VCM, the automated system was modified, creating an external VCM that can be disinfected. To substantiate our hypothesis and to confirm the efficacy of the
Results
In the aspiration fluid from the machines with internal VCMs, 4+ bacterial growth was observed in 13 of the 25 cases, 3+ in 11 cases, and 2+ in 1 case (Fig 5). By contrast, all 12 samples from the machine with an external VCM (control group) remained sterile. Statistical analysis showed 100% contamination of aspiration fluid in machines with an internal VCM in contrast to 0% in the machine with the external VCM (chi-square: P = 0.0001). Details of the microbiologic cultures are shown in Table 1
Discussion
In 25 of 25 intraocular operations performed with three approximately 1-year-old irrigation/aspiration systems, we found severe contamination of the aspiration fluid by several ubiquitous bacteria, including M. luteus, S. maltophilia, C. acidovorans, Chryseomonas spp., F. meningosepticum, and A. radiobacter. It is noteworthy that S. maltophilia and A. radiobacter were among the three most frequently isolated species in all three experimental groups. These bacteria are widely distributed in the
Acknowledgements
The authors thank the Max-von-Pettenkofer-Institute for Hygiene and Medical Microbiology of the Ludwig-Maximilians-University of Munich for identification of the bacteria. We also thank Michael Brown, of the University of Würzburg, Germany, for carefully reading the manuscript.
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