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Pneumococcal Endophthalmitis after Corneal Transplantation Control by Modification of Harvesting Techniques

Published online by Cambridge University Press:  21 June 2016

Peggy J. Moore ,
Calvin C. Linnemann Jr. ,
James J. Sanitato  and
Beth Binnion
Peggy J. Moore*
Affiliation:
Injection Control Department, University of Cincinnati Hospital, and Departments of Medicine and Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio
Calvin C. Linnemann Jr.
Affiliation:
Injection Control Department, University of Cincinnati Hospital, and Departments of Medicine and Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio
James J. Sanitato
Affiliation:
Injection Control Department, University of Cincinnati Hospital, and Departments of Medicine and Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio
Beth Binnion
Affiliation:
Injection Control Department, University of Cincinnati Hospital, and Departments of Medicine and Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio
*
Infection Control, University Hospital, 234 Goodman Street, Cincinnati, OH 45367-0788
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Abstract

Between January and September 1986, 61 patients underwent corneal transplantation at a university hospital, and three (4.9%) of the patients developed endophthalmitis. Cultures of the donor cornea were positive for Streptococcus pneumoniae. The transplant program was stopped and an investigation begun. Review of corneal transplants in 1985 showed that S pneumoniae was recovered from only 1 (1.5%) of 66 donor corneas compared with 6 (9.8%) of 61 in 1986 (P = 0.045; Fisher's exact test). Investigation showed that major changes had occurred in the corneal transplant program in 1986 as a result of a new state law. Coroner's cases had become the source of most corneas; younger donors were available, and corneas, instead of whole eyes, were collected in the coroner's office, often by part-time technicians. All of the infected corneas had been harvested by part-time technicians, instead of the regular eye bank technician, and came from younger donors (mean age 11.8 years v 27.2; P ≤ 0.02). Based on these observations, collection techniques were modified to reduce contamination of corneas during harvesting. This included the use of surgical drapes and gloves, collecting the cornea without interruption, saline irrigation of the eye, and inversion of the eye chamber to ensure complete contact of the cornea with the antibiotic-containing media. The program was restarted, and there were no corneal infections with S pneumoniae during a one-year follow-up period. The study indicates that techniques sufficient to prevent infection when whole eyes were taken and the cornea harvested by experienced technicians were not effective for direct harvesting of corneas in a coroner's office by less experienced technicians. The use of younger donors may also increase the risk of S pneumoniae contaminating the cornea and require additional measures for control.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 10 , Issue 3 , March 1989 , pp. 102 - 105
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1989

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