Hand hygiene in routine glaucoma clinics

Abstract

Bilateral naevus of Ota with choroidal melanoma and diffuse retinal pigmentation in a dark skinned person Naevus of Ota (naevus fusculocoeruleus ophthalmomaxillaris) was described by the Japanese dermatologist, Ota, in 1939 as a dermal melanocytic hamartoma that presents as bluish hyperpigmentation along the ophthalmic, maxillary, and mandibular branches of the trigeminal nerve. It is bilateral in less than 5% cases, occurring frequently in Orientals (0.2%-1%) and darker races and rarely in white people (0.04%). Open angle glaucomas and choroidal melanoma are the rare ocular involvements. Ota's naevus is more common in Asians than white people but uveal melanoma occurs predominantly in white populations. 1 2 Dark skinned patients represent only 1% of all cases of orbital melanomas. 3 The risk of developing uveal melanoma in a patient with naevus of Ota is one in 400 patients in their lifetime. 1 2 We report a rare case of bilateral naevus of Ota with a right (RE) choroidal melanoma and left (LE) diffuse pigmentation of retina. Case report A 73 year old Anglo-Indian woman was referred with complaints of photopsia. She had black hair and light brown skin. Examination revealed a brownish-black pigmentation of the conjunctiva, episclera, and periocular skin bilaterally (fig 1). Visual acuity for distance and near was 6/6 and N5, respectively, in each eye. Heterochromia was present, the right iris being a darker brown than the left, which had a sector of light brown colour. Gonioscopy and intraocular pressure were normal. The right fundus revealed a pigmented, large, elevated choroidal mass 10 disc diameter (DD) in size, 4 DD superonasal to the disc. Drusen were overlying it. No subretinal fluid was seen. The left eye showed a patchy dark pigmentation 3 DD in size, at the temporal edge of the macula. A ridge-like pigmented elevation, 3 DD long, was also seen along the superonasal vessels. Both optic discs and maculas were normal. Ultrasound in the right eye showed a 10 mm tumour, 4.2 mm high. Fluorescein angiography confirmed its independent circulation. A systemic examination found no signs of metastasis. A diagnosis of a

Utility of electronic hand hygiene counting devices for measuring physicians' hand hygiene adherence applied to outpatient settings

“…We have not provided feedback about individual physicians' compliance rates in this study; instead, we have started the reporting of monthly hand hygiene adherence rates for each clinical department that takes place at the monthly directors' meeting. As with previous reports, 1,[12][13][14][15] audit and feedback of hand hygiene performance resulted in a significant increase in hand hygiene compliance at the hospital, department, and individual physician levels. However, our methods, based on compliance rate results, were insufficient for hand hygiene improvement initiatives because overall hand hygiene compliance was still low at 18.2%, and only 17.1% of physicians were considered as responders after feedback.…”

“…Previous studies performed in dermatology and glaucoma clinics demonstrated that baseline hand hygiene adherence (attempts/ opportunities) measured by direct observation was 31.4% (174/555) and 18% (44/249), respectively. 13,14 Similarly, direct observation of hand hygiene adherence performed in oncology and gastrointestinal clinic was reported as 11% (74/684) and 21% (164/798) at baseline, respectively. 12 Direct comparison of results obtained in these studies with the results of this study was difficult because the sample sizes were relatively small and were performed only at 1 or 2 clinic or department.…”

“…Most studies focusing on hand hygiene are targeted at inpatient settings, and there have been relatively few intervention studies performed in outpatient settings. [12][13][14] Although the risk of HCAI in outpatient settings might be lower than in inpatient settings, hand hygiene compliance among physicians can be monitored more precisely and easily compared with inpatient settings when electronic counting devices are used.…”

Hand hygiene practices among ophthalmologists

“…A recent study showed that, using covert observation, handwashing episodes in a glaucoma clinic were only 18%; this increased to 28% when it was remonitored after the preliminary results were presented and distributed by memo. 8 Although this was statistically significant, it was far from the hospital standard. Therefore, we believe that continuous re-inforcement is necessary to improve adherence levels.…”

Reactive arthritis developing after pneumococcal conjunctivitis: a case report

“…Studies have shown that hand hygiene is not always practised by a substantial proportion of ophthalmic healthcare workers [10] and that ophthalmologists can carry a significant microbial load on their hands [11]. This case shows the risk faced by healthcare workers whilst treating infected patients and highlights the importance of the implementation of hygienic measures by both patients (through education on the importance of frequent hand washing and avoiding the sharing of eating utensils/towels) and healthcare workers to reduce the risk of transmission.…”