News and notices. Comm Eye Health Vol. 16 No. 47 2003. September 01, 2003

Authors’ abstracts

Effectiveness of a hospital-wide programme to improve compliance with hand hygiene

Didier Pittet, Stéphane Hugonnet, Stephen Harbarth, Philippe Mourouga, Valérie Sauvan, Sylvie Touveneau, Thomas V Perneger, and members of the Infection Control Programme

Background: Hand hygiene prevents cross infection in hospitals, but compliance with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel.

Methods: We monitored the overall compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, Switzerland, before and during implementation of a hand hygiene campaign. Seven hospital-wide observational surveys were done twice yearly from December, 1994, to December, 1997. Secondary outcome measures were nosocomial infection rates, attack rates of methicillin-resistant Staphylococcus aureus (MRSA), and consumption of handrub disinfectant.

Findings: We observed more than 20000 opportunities for hand hygiene. Compliance improved progressively from 48% in 1994, to 66% in 1997 (p<0.001). Although recourse to hand washing with soap and water remained stable, frequency of hand disinfection substantially increased during the study period (p<0.001). This result was unchanged after adjustment for known risk factors of poor adherence. Hand hygiene improved significantly among nurses and nursing assistants, but remained poor among doctors. During the same period, overall nosocomial infection decreased (prevalence of 16.9% in 1994 to 9.9% in 1998; p=0.04), MRSA transmission rates decreased (2.16 to 0.93 episodes per 10000 patient-days; p<0.001), and the consumption of alcohol-based handrub solution increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 (p<0.001).

Interpretation: The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.

Published courtesy of : Lancet 2000; 356: 1307-1312

Topical mitomycin-C for partially excised conjunctival squamous cell carcinoma

Frucht-Pery J, Rozenman Y, Pe’er J

Purpose: To evaluate the efficacy of topical mitomycin-C (MMC) for treatment of post-operative residual conjunctival squamous cell carcinoma (SCC).

Design: Retrospective non-comparative case series.

Participants: Five patients, two males and three females, with conjunctival and histologically proven incompletely excised conjunctival SCC.

Methods: Patients were treated with topical MMC. Two to three courses of topical MMC, 0.02% or 0.04%, were applied four times daily for 14 days per course. One month after the final treatment, the scar area with surrounding normal conjunctiva was excised, and histologic evaluation was done.

Main outcome measures: No evidence of malignant cells in excised tissues.

Results: Histologic evaluation of the five specimens showed no malignant cells. Conjunctival scarring with inflammatory response was observed. No regrowth was reported during the follow-up period of 18 to 37 months. The complications of MMC use included mild to moderate conjunctival hyperemia in three patients. All signs and symptoms were resolved after discontinuation of the treatment.

Conclusions: Application of topical MMC is an efficient treatment for residual conjunctival SCC. Longer follow-up is required to confirm these findings.

Published courtesy of: Ophthalmology 2002; 109(3): 548-552

Use of mitomycin C in the treatment of corneal conjunctival intraepithelial neoplasia

Daniell M, Maini R, Tole D

Purpose: To evaluate the efficacy of topical mitomycin C as a treatment of corneal conjunctival intraepithelial neoplasia.

Methods: An open prospective analysis of 20 cases of corneal conjunctival intraepithelial neoplasia with recurrent disease (17 patients) or refusing surgery (three patients) were treated with topical mitomycin C. Treatment was with mitomycin C eye drops, either 0.02% or 0.04%, four times daily for 1 week followed by a week off, the cycle then repeated for a second week.

Patients were examined weekly until the lesions were eradicated.

Results:Clinical resolution of disease occurred in 18/20 cases. The mean time to resolution was 4.5 weeks, the mean number of cycles of treatment was two. Average follow up was 13 months with four cases of recurrent disease. These four cases were retreated with complete resolution in two cases. Epithelial toxicity occurred in 10/20 eyes and lid toxicity in two cases. There were no long-term complications on discontinuing mitomycin C.

Conclusions: Mitomycin C is effective in inducing regression of corneal conjunctival intraepithelial neoplasia. Complications are common but self-limiting. An optimal regimen is still to be established.

Published courtesy of: Clin Experiment Ophthalmol 2002; 30 (2): 94-98

Ocular disease in patients with tuberculosis and HIV presenting with fever in Africa

N A V Beare, J G Kublin, D K Lewis M J Schijffelen, R P H Peters G Joaki, J Kumwenda, E E Zijlstra

Aims: To investigate ocular disease in patients with tuberculosis (TB) and HIV in Africa presenting with fever, and to determine if indirect ophthalmoscopy is useful in the diagnosis of mycobacteraemia.

Methods: A prospective study of all adult patients admitted with fever to a large central hospital in Malawi, Africa. All recruited patients had an ophthalmic examination, HIV tests, chest xray, sputum examinations, bacterial and mycobacterial blood cultures, and malaria slide to observe the presence of parasites.

Results: 307 patients were recruited; 109 (36%) had TB, including 53 (17%) with mycobacteraemia; 255 (83%) had HIV and 191 (62%) had AIDS. Of the patients with TB, 102 (94%) had HIV. Choroidal granulomas were found in four patients, all of whom had AIDS; three (2.8% of those with TB) had disseminated TB with mycobacteraemia, and one had persistent fever but no other evidence of TB. Among the patients with AIDS, 32 (17%) had microangiopathy manifest by cotton wool spots; one (0.5%) had signs of active cytomegalovirus (CMV) retinitis. The presence of microangiopathy was not related to TB.

Conclusions: In Malawian patients with TB presenting acutely with fever, choroidal granulomas were found in 2.8%, and were concurrent with mycobacteraemia and AIDS. Ophthalmoscopy was not a useful aid in the diagnosis of mycobacteraemia. Cytomegalovirus (CMV) retinitis is rarely seen in African AIDS patients. This may be the result of mortality early in the disease course, or differences in race, HIV subtype, or comorbidity.

Published courtesy of: Br J Ophthalmol 2002; 86: 1076-1079

AIDS related eye disease in Burundi, Africa

Isabelle Cochereau, Najoua Mlika-Cabanne, Philippe Godinaud, Théodore Niyongabo, Bernard Poste, Athanase Ngayiragije, Marie-Christine Dazza, Pierre Aubry, Bernard Larouzé

Aims: To determine the prevalence of ocular manifestations in AIDS patients hospitalised in Bujumbura, Burundi, according to their CD4+ lymphocyte count, serological status for CMV and VZV, and general health status.

Methods: Prospective study of 154 consecutive patients who underwent general and ophthalmological examinations, including dilated fundus examination. AIDS was diagnosed on the basis of Bangui criteria and HIV-1 seropositivity. CD4+ lymphocyte counts were determined by the Capcellia method. CMV and VZV antibodies were detected with ELISA methods.

Results: The mean age was 37 (SD 9) years and 65% of the patients were male. Active tuberculosis was the most frequent underlying disease (61%). Almost all the patients (99%) were seropositive for CMV and VZV. Among the 115 patients for whom CD4+ lymphocyte counts were available, 86 (75%) had more than 100 cells x106/l. Ocular involvement comprised 16 cases of microangiopathy, six of opalescence of the anterior chamber, five of retinal perivasculitis, two of zoster ophthalmicus, two of viral retinitis, and one of opalescence of the vitreous.

Conclusion: In Africa, the prevalence of ocular involvement in HIV infection is far lower than in Europe and the United States, possibly because most African patients die before ocular opportunistic infections occur.

Published courtesy of: Br J Ophthalmol 1999; 83: 339-342

Penetrating needle injury of the eye causing cataract in children

Peter K Rabiah MD

Purpose: To review the presentation, management, and outcome of children with cataract caused by ocular needle penetration.

Design: Retrospective, non-comparative interventional case series.

Participants: Forty-two children with cataract caused by ocular needle penetration.

Intervention: Cataract surgery.

Main outcome measures: Best-corrected post-operative visual acuity.

Results: Injuries were unintentional and occurred during unsupervised play. The type of needle involved was hypodermic in 24 cases, sewing in 7, and undetermined in 11. Endophthalmitis developed in 14 cases and retinal detachment in 6. Endophthalmitis occurred in 12 cases (50%) of hypodermic needle injury but in no case of sewing needle injury. With a mean postoperative follow-up of 2.3 years, the best-corrected visual acuity was 20/40 or better in 19 cases, 20/50 to 20/80 in 7, 20/100 to counting fingers in 6, light perception in 1, no light perception in 6, and undetermined in 3. Eyes with endophthalmitis and/or retinal detachment had a worse visual prognosis.

Conclusions: Ocular penetration causing cataract occurred in children during unsupervised play with inadequately stored or disposed of hypodermic or sewing needles. Endophthalmitis occurred frequently in injuries caused by hypodermic needles but not in those caused by sewing needles. Visual outcome after management was good in approximately half of the cases especially if endophthalmitis or retinal detachment did not develop.

Published courtesy of: Ophthalmology 2003; 110: 173-176

News and notices in Comm Eye Health Vol. 16 No. 47 2003 –