Disinfection of Eyelid Specula With Chlorhexidine Gluconate (Hibiclens) After Examinations for Retinopathy of Prematurity

Abstract

Background: The preferred method of cleaning eyelid specula between examinations for retinopathy of prematurity is unknown. A previous study showed that disinfection with 70% isopropyl alcohol swabs fails to eliminate viruses and bacteria from the specula. Objective: To determine if alternative sterilization procedures would allow multiple use of a single speculum without risking nosocomial infection. Methods: In phase 1, 40 autoclave-sterilized eyelid specula were randomized into either "cleaned" or "patient control" groups after being used for routine retinopathy of prematurity examinations performed in the outpatient setting. Specula in the cleaned group were cleaned with chlorhexidine gluconate (Hibiclens). Specula in the patient control group were not cleaned after use. All study specula were placed into enriched culture media from which bacterial and fungal cultures were obtained. In phase 2, 20 autoclave-sterilized eyelid specula were inoculated with a clinically relevant dilution of adenovirus serovar 5 or herpes simplex type 2. Specula were randomized into either a cleaned or a con

Brote nosocomial de queratoconjuntivitis epidémica en una Unidad de Cuidados Intensivos Neonatal

“…No es inactivado por detergentes pero sí por soluciones alcohólicas al 70% o de Clorhexidina, que sería lo recomendable; no obstante, estudios demuestran que el autoclave es el método ideal para la esterilización de blefarostatos en el examen de fondo de ojo en prematuros, quedando como alternativa la desinfección con gluconato de clorhexidina o isopropil alcohol al 70% (18,19). Además, se deben extremar las medidas de higiene en unidades de riesgo para evitar la diseminación.…”

Use of nonsterile instruments for examination for retinopathy of prematurity in the neonatal intensive care unit

“…7,8,12 Currently used eyelid speculum-cleansing techniques other than sterilization include alcohol rinsing, chlorhexidinegluconate and glutaraldehyde cleaning, and autoclave sterilization. 13,14 Of these, only glutaraldehyde exposure for 20 minutes is considered high-level disinfection. 6 Glutaraldehyde might cause corneal decompensation if not adequately rinsed from eye instruments.…”

“…15 Chlorhexidine gluconate and alcohol are inadequate for disinfecting eyelid speculae. 13,14 Chlorhexidine gluconate, even in low concentration, carries the risk of producing permanent corneal damage, including bullous keratopathy. 16,17 If a hospital does not provide instruments, an ophthalmologist might bring a single pair of nonsterile instruments to the NICU for multiple examinations.…”

Healthcare-Associated Viral Infections: Considerations for Nosocomial Transmission and Infection Control

“…Sodium hypochlorite (dilute bleach) appears to effectively disinfect HSV on reusable tonometers and specula used for eye exams. In some studies 70% isopropyl alcohol was also an effective disinfectant against HSV on eye specula [37,38,75].…”