Slit lamps and lenses: a potential source of nosocomial infections?

Sobolewska, Bianka; Buhl, Michael; Liese, Jan; Ziemssen, Focke

doi:10.1038/s41433-017-0004-0

Cited by 11 publications

(9 citation statements)

References 38 publications

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“…This is in line with previous findings for spectacles and microscope oculars, where we found largely the same dominant taxa. We could also prove the presence of staphylococci, which matches the cultivation-based detection of coagulase-negative staphylococci by Sobolewska et al (Sobolewska et al, 2018). While they identified staphylococci as the most frequent bacteria on slit lamps, we found this genus in lower proportions, which may be due to the use of different methods.…”

Section: Discussionsupporting

confidence: 88%

Comprehensive Compositional Analysis of the Slit Lamp Bacteriota

Fritz

Paschko

Young

et al. 2021

Front. Cell. Infect. Microbiol.

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Slit lamps are routinely used to examine large numbers of patients every day due to high throughput. Previous, cultivation-based results suggested slit lamps to be contaminated with bacteria, mostly coagulase-negative staphylococci, followed by micrococci, bacilli, but also Staphylococcus aureus. Our study aimed at obtaining a much more comprehensive, cultivation-independent view of the slit lamp bacteriota and its hygienic relevance, as regularly touched surfaces usually represent fomites, particularly if used by different persons. We performed extensive 16S rRNA gene sequencing to analyse the bacteriota, of 46 slit lamps from two tertiary care centers at two sampling sites, respectively. 82 samples yielded enough sequences for downstream analyses and revealed contamination with bacteria of mostly human skin, mucosa and probably eye origin, predominantly cutibacteria, staphylococci and corynebacteria. The taxonomic assignment of 3369 ASVs (amplicon sequence variants) revealed 19 bacterial phyla and 468 genera across all samples. As antibiotic resistances are of major concern, we screened all samples for methicillin-resistant Staphylococcus aureus (MRSA) using qPCR, however, no signals above the detection limit were detected. Our study provides first comprehensive insight into the slit lamp microbiota. It underlines that slit lamps carry a highly diverse, skin-like bacterial microbiota and that thorough cleaning and disinfection after use is highly recommendable to prevent eye and skin infections.

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Section: Discussionsupporting

confidence: 88%

Comprehensive Compositional Analysis of the Slit Lamp Bacteriota

Fritz

Paschko

Young

et al. 2021

Front. Cell. Infect. Microbiol.

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“…These may be due to production and material defects during manufacturing or may have occurred during packaging and shipping. Even if vigilance against volatile particles and aerosols is increased during these days of the COVID-19 pandemic [ 6 ], smooth surfaces or inorganic materials may contain bacterial deposits and contamination [ 7 , 8 ]. It was shown that by no means must the patients' own conjunctiva be regarded as the only source of potential contamination but also the material used [ 9 , 10 ] and the oral flora of the staff [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Impurities in Drug Vials Intended for Intravitreal Medication

Pohl

Strudel

Dimopoulos

et al. 2020

Case Reports in Ophthalmological Medicine

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Sterility is an important prerequisite for minimizing the risk of severe vision loss due to endophthalmitis after intravitreal injections. We describe three cases series of incidents where an unclear contamination of the drug solution or syringe caused the injection process to stop and continue with a new preparation. During a period of 12 months with 30,502 intravitreal injections at a tertiary center, wherein 7,076 were of the drug Aflibercept drawn up from a glass vial, three cases of the critical incident reporting system relating to intravitreal injections were identified: (1) After a typical contact with the filter cannula, the glass of an Aflibercept vial was no longer intact. (2) In the course of another injection, there was a clear deposition of debris on the outer edge of the syringe when removing the attached filter cannula. (3) After inserting the syringe into the rubber top of the vial, a whitish particle of unclear origin was identified within the drug solution. Later, this contamination/particle was identified as part of the greyish rubber that was punched out with the cannula, according to the analyses of the material sent in and the manufacturer’s investigations. Thus, even in busy clinics, visual inspection of the injection solution and materials used for impurities, preferably before and after pulling them out of a vial, must be an essential part of the injection process. Even when using ready-to-use prefilled syringes (PFS), vigilance must be kept high, knowing the risk of potential contamination.

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“…Goldmann-type contact lenses, laser surgery lenses, gonioscopy lenses, and others] are vectors for nosocomial infection during an ophthalmologic examination. 40,41 In order to limit the number of patients coming into contact with a single lens, many ophthalmology departments, including our own, have suspended the use of trial lenses and trial framing, and are only performing refractions in rare situations. 28 Singleuse diagnostic or therapeutic lenses, such as those offered by some manufacturers (eg, Volk Optical and Katena), can reduce the potential for transmission of infection and eliminate the time required for disinfection without affecting image quality.…”

Section: Lensesmentioning

confidence: 99%