 Good Evening !!!!!!!

POST OPERATIVE INFECTION TROUBLE SHOOTING  PRE - OPERATIVE  INTRA – OPERATIVE  POST - OPERATIVE

PRE - OPERATIVE  OUT PATIENT DEPARTMENT  WARD  THEATRE

OUT PATIENT DEPARTMENT  Preop. examination  Lids – blepharitis, meibominitis, chalazion, pustules.  Conj – congestion  Cornea – Infiltrate, KPS  Uveitis  Investigations- Duct - Culture/Sensitivity

WARD  Instillation of regular antibiotic drops – 4 Times  Proper cleaning of eyes.  Scrutinizing the case sheet.  Preop. Counselling.

THEATRE  Patient factor  Nurse factor  Instrument and Sterilization factor.  Theatre products factor  Surgeon factor

PATIENT FACTOR  Hygiene and cleanliness of individual.  Difficulty in communication due to old age,illiteracy and deafness.  Not telling about other systemic diseases and hence the importance of proper Counselling.

NURSES FACTOR  Personal hygiene  Uncorrect way of washing and scrubbing.  Contact with unstrelised part of microscope/ other machines.  Reuse of instrument should be avoided ie., From one table to another table.  Surgeons and scrub nurses should avoid keeping in touch with the back side of the Table ( due to unsterility)  Running nurse should avoid contact with sterile area.

INSTRUMENTS AND STERILIZATION  Proper and strict sterilization to be maintained in all theatre activities.  Block room  OT Table  In Between Sterilization  General Sterilization  Gas Sterilization  Over all OT Atmosphere

BLOCK ROOM  Eye cleaning – TWICE  Instillation of Eye Drops in sterile manner  Use of sterile needles and swabs.

OT TABLE  Check the holes in the autoclaved bin  Eye cleaning – 3 rd time  Sterile draping  Checking the sterility of  instruments  RL bottle  Viscoelastic ( Autoclaved )

 Cautery forceps  Syringes  Vitrectomy cutter  Simcoe cannula  Phacotubing  Cassette  Cannula, IV set Irrigating Vectis  Microscope-sterile cups  Gloves  Running nurses should always open the surgical things in a sterile manner.

IN BETWEEN STERILIZATION  Strict usage of gloves.  Washing of instruments with boiled mineral water.  Simcoe cannula,phacotip, I/A hand piece, cannulas, vectis all things should be washed with RL.  KNIFE sets to be washed in a separate basin ( Boiled water )  Autoclave indicator tape to be kept separately in each instrument tray.  Sterilization timing should be followed as below as 30 pound pressure : 121 degree Centigrade Temp : 10 Min  Check the colour change in the indicator.  Check whether the autoclaved things are dry.

GENERAL STERILIZATION  Basin – 4 Mineral Water washing with Bodetex Forte  Instruments should be Cleaned with brush and dried.  Sterile Tip – Covered  Bin should be washed and kept dry.  Instruments bin should be packed loosely.  Auto Clave indicator should be kept in 4 places.  Daily dispose the Visco cannula.  All Instruments should be cleaned once in 15 days using Ultra Sound Cleaner.  Sterilization timing should be followed as below as 20 Pound Pressure : 121 degree Temp : 45 Min

GAS STERILIZATION  All the plastic items should be re-sterilised with Ethylene Oxide.  Properly seal the cover.  Strictly follow the gas Sterilization time.  Check the colour change in the indicator tape.

OT Cleaning  OT should be cleaned thoroughly.  Weekly once OT floor and Tiles should be washed.  AC Filter should be cleaned weekly twice.  Monthly once OT Culture should be taken.  Daily Formaline Fumigation should be carried out at OT.  After OT Cleaning nobody should enter till next morning.  Stretcher Should be kept for inside and Outside separately.  Linen should be washed within the OT campus.  Water tank should be cleaned once a month.

 The Floor, tiles, Furniture etc., should be cleaned using the chemical as below  Floor - Microl – F  Tiles - Microl – F  Furniture - Instrulean  Equipments - Bacillol  Instruments - Bodetex Forte

POST OPERATIVE CARE  Before cleaning the operated eye, sister should wash her hand.  After surgery, the patient eye should be cleaned properly.  After cleaning 20 patients, use hand rub to clean hands again.  The drops should be applied in Sterile Method.  Ward should be clean.  After surgery, post-op counselling should be advised.  In case of patient feeling excessive pain, watering or congestion inform doctor immediately.

 Thank You Very much !!!!!!!