Bacterial flora--A potential source of endophthalmitis after cataract surgery.

OBJECTIVES: To study bacteria from eye lids and conjunctival sac of patients undergoing cataract surgery before and after the application of antiseptics. MATERIAL AND METHOD: Patients undergoing elective cataract extraction in one university hospital were randomly enrolled. Cultures for bacteria and candida were done by swabbing the eye lids before and after cleaning with 4% chlorhexidine gluconate. Subsequently 10% povidone iodine was applied on eye lids and conjunctival sacs. Cultures of specimens from eye lids and conjunctival sac were taken after the application of 10% povidone iodine and at the end of the operation. RESULTS: Fifty-one patients were enrolled. Positive cultures were found in 90.2% and 82.4% before and after cleaning the face with 4% chlorhexidine. After topical application of 10% povidone iodine, only 19.6% had positive cultures from eye lids and conjunctival sac; a significant reduction (p=0.001). At the end of the operation, positive cultures were found from eye lids in 10 patients and from the conjunctival sac in 4 patients. Isolates were skin flora and candida species in 2 patients. None of the patients had endophthalmitis. CONCLUSION: Cleaning eye lids with 4% chlorhexidine followed by applying 10% povidone iodine was effective in decreasing skin flora in cataract surgery. The organisms were not completely eliminated. Postoperative follow-up to detect infectious complications is warranted.

A study on powdering of reusable surgical gloves.

OBJECTIVES: To study the need of powdering surgical gloves and to produce a powdering machine. MATERIAL AND METHOD: The need of powdering surgical gloves was done by questionnaires to directors or chiefs of purchase departments in 29 hospitals across the country. The practice in powdering surgical gloves was given by chiefs of the central sterile supply department (CSSD). A powdering machine was produced by the researchers in consultation with CSSD personnel in a hospital. The quality of powdering surgical gloves was evaluated by infection control nurses in the hospital. Cost comparison was done by a health economist. RESULTS: The study in 2002 revealed that all of the 29 hospitals used recycled surgical gloves. Powdering of surgical gloves was done by hand in 27.6% and by powdering machine in 62.10%. Corn powder was used in 55.2% and talc in 41.4%.Defects in powdering ranged from 1.1% to 51.7%. No defects was found in surgical gloves powdered by the machine produced by the researchers. The costs for powdering and one pair of reused surgical gloves were 0.10 and 5.59 baht respectively. CONCLUSION: Surgical gloves were reused in all hospitals in Thailand The powdering machine was effective and was not difficult to make.

Prevention and treatment of infectious diseases in healthcare workers.

OBJECTIVES: To study the prevention and treatment of infectious diseases offered to healthcare workers (HCWs) in Thailand. MATERIAL AND METHOD: Data were collected by interviewing in 2002. RESULTS: A total 1,218 HCWs in 33 hospitals were interviewed. Nurses and doctors were the majority group, accounting for 31.5% and 30.5% respectively. Pre-employement health screenings were done by physical examination in 56.0% and chest X-ray in 55.7% and immunization against hepatitis B and tubuculosis were offered in 17.7% and 11.4% respectively. Annual physical examination and chest x-ray were done in 66.3% and 76.9%. Reported infection with hepatitis A hepatitis B, tuberculosis in HCWs were as high as 16.8%, 4.0% and 2.6% respectively. Only 3.5% to 24.3% of HCWs ever read guidelines on the prevention of infection. Existing laws allowed the implementation of prevention, treatment and compensation in case of occupationally acquired infection in HCWs. CONCLUSION: Prevention of infection in HCWs was implemented far below the ideal level. They should be better protected under existing laws.