Corneal ulcers associated with disposable hydrogel contact lenses.

Four patients developed corneal ulcers associated with the use of disposable extended-wear hydrogel contact lenses. Bacteria were recovered from corneal ulcers in three of the patients. Three patients discarded their contact lenses after ten or more days of extended wear; the corneal ulcers in these patients developed toward the end of the wearing cycle. The fourth patient removed her contact lenses every two days for cleaning and disinfection and discarded them for a new pair on a weekly basis. Improper lens hygiene was noted in only one patient. All corneal ulcers responded to antibiotic treatment. In three patients visual acuity returned to normal, but scarring of one patient's cornea resulted in a visual acuity of 20/60.

Reuse of hemodialyzers. Results of nationwide surveillance for adverse effects.

In 1986, the Centers for Disease Control, in collaboration with the Health Care Financing Administration, surveyed 1350 chronic hemodialysis centers in the United States to ascertain practices associated with the reuse of disposable hemodialyzers and the frequency of pyrogenic reactions and septicemia among patients. Reuse of hemodialyzers was reported by 63% of the centers. Centers that used RenNew-D (n = 5) for reprocessing hemodialyzers, compared with centers that did not reuse (n = 495), were more likely to report pyrogenic reactions (60% vs 13%) and episodes of septicemia (100% vs 55%) among their patients. Reusing hemodialyzers more than 20 times and, in some instances, also using manual reprocessing systems was significantly associated with clustering of pyrogenic reactions regardless of the type of germicide used. To detect membrane leaks developing after multiple reuses, air-pressure-leak tests should be performed on all reprocessed hemodialyzers.

Pyrogenic reactions associated with the reuse of disposable hollow-fiber hemodialyzers.

We investigated 18 pyrogenic reactions (PRs) that occurred between July 1 and 13, 1987, in 16 patients receiving long-term hemodialysis at one dialysis center in Illinois. We defined a case of PR as the onset of chills or fever (oral temperature, greater than or equal to 37.8 degrees C) in a patient who was afebrile and had no signs or symptoms of infection before a dialysis treatment. Pyrogenic reactions to dialysis sessions during the epidemic period (July 1 through 14) were associated with the use of a reused dialyzer (risk ratio, 6.2; 95% confidence interval, 0.8 to 45). The water used to rinse the dialyzers after use and to dilute the germicide for disinfecting the dialyzers contained high concentrations of endotoxins (greater than 6 ng/mL) and bacteria (greater than 10(4) colony forming units/mL). After reuse of dialyzers was discontinued at the center, the PR rate fell to pre-epidemic levels. We concluded that PRs were associated with reuse of dialyzers, probably contaminated with endotoxins. Active surveillance for PRs among patients undergoing long-term hemodialysis should be routine at all dialysis centers; an increase in PRs should prompt timely review of water treatment and dialyzer reprocessing systems.

Reuse of disposable catheters and guide wires.

Recent government directives and manufacturers' warnings have strongly cautioned against reuse of angiographic catheters and guide wires following cleaning and sterilization. Though it is theoretically possible that complications might result from reuse, actual documentation is lacking. Complete sterility can be achieved by standard procedures even when the devices are intentionally infected. Survey data indicate no increased incidence of mechanical malfunction when these devices are reused.

Granulomatous peritonitis due to cellulose fibers from disposable surgical fabrics: laboratory investigation and clinical implications.

Two patients with postoperative granulomatous peritonitis were found to have lesions with a distinctive type of foreign body. Laboratory investigation revealed this foreign body to be cellulose, morphologically identical with fibers derived from disposable surgical gowns and drapes, and cotton. The same type of foreign body granulomas was produced experimentally by introducing lint prepared from these gowns and drapes into the peritoneal cavities of rats. Since disposable gowns and drapes are being used with increasing frequency, cellulose lint derived from these sources should be added to the list of hazardous foreign materials which are potential wound contaminants.