A systematic review and cost-effectiveness analysis of tonometer disinfection methods

Akhtar, A. Omar; Singh, Hargurinder; Si, Francie; Hodge, William

doi:10.1016/j.jcjo.2014.04.003

Cited by 10 publications

(16 citation statements)

References 23 publications

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“…The use of disposable prisms is also an option, though many times this method is of limited use due to cost. 28,29 Because of these unique viral characteristics, ubiquity of HAdV, and its potential for epidemic, several treatment modalities have been investigated to establish an effective treatment protocol. However, at this stage, there is no FDA-approved antiviral treatment for HAdV infections.…”

Section: Managementmentioning

confidence: 99%

<p>Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions</p>

Labib¹,

Minhas²,

Chigbu³

2020

OPTH

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Human adenovirus (HAdV) is the most common cause of infectious conjunctivitis, accounting for up to 75% of all conjunctivitis cases and affecting people of all ages and demographics. In addition to ocular complications, it can cause systemic infections in the form of gastroenteritis, respiratory disease, and dissemination in immunocompromised individuals. HAdV causes lytic infection of the mucoepithelial cells of the conjunctiva and cornea, as well as latent infection of lymphoid and adenoid cells. Epidemic keratoconjunctivitis (EKC) is the most severe ocular manifestation of HAdV infection, in which the presence of subepithelial infiltrates (SEIs) in the cornea is a hallmark feature of corneal involvement. SEIs have the tendency to recur and may lead to long-term visual disability. HAdV persistence and dissemination are linked to sporadic outbreaks of adenoviral keratoconjunctivitis. There is no FDA-approved antiviral for treating adenoviral keratoconjunctivitis, and as such, solutions should be proffered to handle the challenges associated with viral persistence and dissemination. Several treatment modalities have been investigated, both systemically and locally, to not only mitigate symptoms but reduce the course of the infection and prevent the risk of long-term complications. These options include systemic and topical antivirals, in-office povidone-iodine irrigation (PVI), immunoglobulin-based therapy, antiinflammatory therapy, and immunotherapy. More recently, combination PVI/dexamethasone ophthalmic formulations have shown favorable outcomes and were well tolerated in clinical trials for the treatment of EKC. Possible, future treatment considerations include sialic acid analogs, cold atmospheric plasma, N-chlorotaurine, and benzalkonium chloride. Continued investigation and evaluation of treatment are warranted to reduce the economic burden and potential long-term visual debilitation in affected patients. This review will focus on how persistence and dissemination of HAdV pose a significant challenge to the management of adenoviral keratoconjunctivitis. Furthermore, current and future trends in prophylactic and therapeutic modalities for adenoviral keratoconjunctivitis will be discussed.

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Section: Managementmentioning

confidence: 99%

<p>Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions</p>

Labib¹,

Minhas²,

Chigbu³

2020

OPTH

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“…The Canadian Ophthalmological Society requires that tonometer tips are disinfected between patients; however, instructions regarding a specific sterilization technique have not been provided [ 11 ]. There is variation amongst the sterilization techniques chosen to disinfect tonometer tips, and controversy continues to exist regarding the most effective method of sterilization [ 12 ]. A national survey has identified that alcohol swabs are the primary disinfectant technique amongst 71% of Canadian ophthalmologists, who participated in the survey [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…There is variation amongst the sterilization techniques chosen to disinfect tonometer tips, and controversy continues to exist regarding the most effective method of sterilization [ 12 ]. A national survey has identified that alcohol swabs are the primary disinfectant technique amongst 71% of Canadian ophthalmologists, who participated in the survey [ 12 ]. The current published literature also suggests several other disinfection methods, including: placing the tonometer tip in running water, wiping the tonometer tip with at least two surfaces of a clean cotton ball (soaked with water or saline), cleaning with a dry tissue, and the use of alcohol or detergents for disinfection [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Tonometer prisms may also be disinfected by soaking the tips in a peroxide solution [ 13 ]. Nevertheless, soaking the tonometer tips is usually an unfavourable technique as the process is time consuming, costly, contributes to tip destruction, and may lead to iatrogenic corneal toxicity [ 12 ]. Additionally, the use of disposable tonometer prisms has been proposed to reduce the risk of infectious disease transmission [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, this systematic review will also compare the current tonometer disinfection methods, and review which sterilization techniques effectively reduce the risk of disease transmission. Currently, more than 122 million patients undergo tonometry annually worldwide [ 12 ]. Consequently, it is essential for clinicians, hospital administrators, and politicians to be informed on the most effective disinfection methods against these infectious diseases.…”

Section: Introductionmentioning

confidence: 99%

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A Systematic Review Regarding Tonometry and the Transmission of Infectious Diseases

Atkins

Hodge

2018

J Clin Med Res

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Tonometry has been identified as a common method for measuring the intraocular pressure in patients. The direct contact between the tonometer and the eye may contribute to the risk of cross infection, especially of viral particles, from one patient to another. A systematic review was undertaken to address the likelihood of human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus, and prion diseases transmission through the use of tonometers. Additionally, a comparison of the current tonometer disinfection methods is provided to assist with identifying which technique effectively reduces the risk of disease transmission. An electronic literature search was conducted using the following databases: Web of Science, EMBASE, CINAHL, SCOPUS, Biosis Previews, Cochrane Library, PubMed, and Google Scholar. Dissertation indexes were also searched, and these included: Dissertations and Abstracts, and Dissertations and Abstracts - UK/Ireland. Additionally, the Clinicaltrials.gov trial registry was searched to identify any other relevant literature. Two independent reviewers critically appraised the articles retrieved through the literature search. In total, 11 unique studies were deemed relevant for this systematic review. The available evidence demonstrated that the use of tonometers contributes to the transmission of these infectious diseases in vitro. The results also demonstrated variability in determining the most effective tonometer sterilization technique against these infectious diseases in vitro. There was limited evidence available regarding the transmission of HIV, hepatitis B, hepatitis C, and prion diseases through the use of tonometers. Additionally, due to the variability regarding the most effective sterilization techniques, it is difficult to identify which sterilization technique is most effective or adequately effective against these infectious diseases. Future research studies regarding infectious disease transmission through tonometry and sterilization techniques should be completed to more adequately inform infectious disease control guidelines.

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