The precautionary principle: what is the risk of reusing disposable drops in routine ophthalmology consultations and what are the costs of reducing this risk to zero?

Abstract

Background Instilling eye drops is a ubiquitous procedure in eye clinics. This audit aimed to assess the risk of contamination of disposable droppers and to quantify the financial and waste implications of reducing this risk to zero by using disposable droppers only once. Methods A total of 100 disposable Minims were used to place one drop in each eye of 70 patients. The dropper tip was then cultured for aerobic and anaerobic microbes. Results Coagulase-negative staphylococcus was cultured from five samples. The contamination rate per drop application was 2.5%. The risk of cross-contamination with coagulase-negative staphylococcus would be between 1 : 400 and 1 : 80 if the bottle was reused once or six times. Reducing this risk to zero costs between d2.75 and d4.6 million per annum and generates between 6.85 and 11.42 more tonnes of paper waste and between 12.69 and 21.15 more tonnes of plastic waste than a strategy that reuses the disposable dropper. Conclusion Reducing the risk of dropper contamination and subsequent cross infection has financial and environmental costs. As exposure to coagulase-negative staphylococcus is not necessarily associated with infection, it would be useful to decide acceptable risk levels for a given cost to maximise both cost-effectiveness and patient safety.

Addressing the environmental sustainability of eye health-care delivery: a scoping review

“…[22][23][24][25] The 16 included studies were all published from 2009 onwards, with an increasing rate of relevant publications in recent years (figure 2). Studies were done in the UK, [26][27][28][29][30] the USA, 23,31,32 India, 22,23,33 New Zealand, 24,34 Malaysia, 35 Ireland, 25 France, 36 and as international collaborations (table). 38 See Online for appendix…”

Microbial Contamination of Extended Use Ophthalmic Drops in Ophthalmology Clinic

“…In ophthalmology outpatient clinics (OOC), a single bottle of preserved ophthalmic drops (POD) is often used on multiple patients 1 , 2 over an extended period of time in order to decrease the cost to the hospital. 3–7 In the OOC of Universiti Kebangsaan Malaysia Medical Center (UKMMC), Malaysia, ophthalmic drops are discarded once or twice a month regardless of how much content remains.…”

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

“…In the digitial medicine also mobile phones [24] and computer keyboards [16] become more relevant vehicles for the transmission of pathogenic microorganisms. Other potential vectors for nosocomial infections are inappropriately or unsuccessfully decontaminated surgical instruments [25] or reusable laserprotective eyeware [26], and reuse of contaminated eye drops [27,28]. Besides, microbial hand contamination during an eye examination contributes to the risk of transmission not only due to contact with the patient's skin but also due to direct contact with the patient's eye discharge and tears [29].…”