Disinfection of Eyelid Speculums for Retinopathy of Prematurity Examination

Abstract

To evaluate the effectiveness of 70% isopropyl alcohol swabs in disinfecting eyelid speculums after examination for retinopathy of prematurity. Methods: Two phases. Phase 1: 46 autoclave-sterilized eyelid speculums randomized into either a cleaned or control group following examination for retinopathy of prematurity. Speculums in the cleaned group were disinfected with a 70% isopropyl alcohol swab while control speculums were not cleaned. Bacterial and fungal cultures were then obtained. Phase 2: 20 autoclavesterilized eyelid speculums inoculated with a clinically relevant dilution of adenovirus serotype 5 or herpes simplex virus type 2. Inoculated speculums were randomized into either a cleaned or control group.

Efficacy and effectiveness of alcohol in the disinfection of semi-critical materials: a systematic review

“…Several techniques were employed to collect samples in the studies which evaluated the effectiveness and efficacy of alcohol disinfection. In the field studies, the following techniques were used: direct plating of the health care product samples in agar plates (6,10) , rubbing a sterile saline solution-soaked sterile compress pad on the product 7 , swab rubbing (absent description whether it was sterile or if had been soaked in a certain solution) 9 , rubbing phosphate buffered saline-soaked sterile swabs on the product 12 , direct inoculating the health care product in a culture broth 17 , rubbing with a sterile compress pad 19 . In the experimental studies, the following collection techniques were used: soaking the health care products tubes in sterile phosphate buffered solution 8 , rubbing with a Letheen broth and Tween neutralizer-soaked sterile swabbing pad 13 , rubbing with a saline-solutionsoaked sterile swab 14 , swab rubbing (absent description regarding whether it was sterile or it had been soaked in a certain solution) 15 , directly inoculating the health care product in sterile saline solution 16 , direct inoculation of the health care product in a viral transportation medium 17 , sterile compress pad rubbing 19 .…”

“…The culture media used in breeding also varied, and they were the following for the field studies: trypticase soy agar that is supplemented with defibrinated sheep blood 6 , 5% blood sheep agar 8 , blood agar (type not described) (9,12) , 1% vitamin K and hemin-enriched blood agar 10 , the kind of medium was not described in one of the studies 11 , trypticase soy broth that was inoculated with trypticase soy agar, chocolate II agar, and MacConkey agar 17 , sample in thioglycolate phosphate buffered solution, run through a 0.4 μm mesh sieve, and breeding the filtrate in blood agar 19 . In the experimental studies, the culture media used were the following: Middlebrook 7H11 agar (for the analysis of mycobacteria 8 agar (type not described) 13 , Mitis salivarius agar, MacConkey agar, Baird Parker agar 14 , brain-heart infusion agar (BHI) 15 , Sabouraud dextrose agar, and BBL agar 16 , Caso-Bouillon fun broth-diluted sample.…”

“…Type 1 herpes simplex virus has not been detected in pediatric eyelid specula, after isopropyl alcohol 70% was rubbed over the whole surface of that health care product for 10 seconds. However, under such conditions, type 5 adenovirus could not be eliminated from the surface of those products 17 . Adenovirus is a hydrophilic virus in which ethyl alcohol, in concentrations from 60 to 80%, should have acted as a virucide agent 20 .…”

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.…”