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Journal of Orthopaedic Surgery 2012;20(1):75-7
Infection risk from surgeons’ eyeglasses
Umer Butt, Urfan Saleem, Kamran Yousuf, Tarek El-Bouni, Andrew Chambler, Ahmed Shawky Eid
Department of Orthopaedic Surgery, Yeovil Hospital, Somerset, United Kingdom
ABSTRACT
Purpose. To assess bacterial contamination of 20
eyeglasses from surgeons.
Methods. 40 samples were taken from the nose pad
(n=20) and earpiece (n=20) of 20 eyeglasses from
orthopaedic surgeons using a sterile swab stick
soaked in sterile distilled water. Swabs were incubated
and inoculated onto 3 plates: Staphylococcus/
Streptococcus agar plate, Mannitol salt plate, and
Chromogenic agar plate. Organisms isolated were
identified.
Results. Of 20 eyeglasses, 19 were contaminated with
Staphylococcus epidermidis (3 of them additionally
grew S haemolyticus or S xylosus) and the remaining
one grew S aureus.
Conclusion. Eyeglasses are a source of surgical
infection. Contamination can be caused by direct
contact of the eyeglasses to the wound and indirect
contact by the surgeon’s fingers, splashes from saline
irrigation, and through air. Therefore, disinfection
should be performed for eyeglasses of surgeons. The
use of surgical visor masks or filtered exhaust helmets
(space suits) are alternatives.
Key words: arthroplasty; eyeglasses; infection control;
Staphylococcus epidermidis; surgical wound infection
INTRODUCTION
Deep infection is a devastating complication that
increases the burden of the health care system.1,2
Prior to introduction of the laminar system, the deep
infection rate was 3.4% and primarily associated with
skin commensals.3 Scrub staff are mandated to wear
occlusive clothing under the laminar flow to reduce
the infection rate. Nonetheless, bacterial loading
can arise from other sources, either from patients
endogenously or from unsterile equipment, drapes,
gowns, or gloves.4,5 The exposed facial area is a source
of infection even if surgical visor masks are worn.6
It is a usual practice for surgeons to tape the
frame of eyeglasses to the nose or temples to avoid
their slipping. Contamination may be caused when
eyeglasses drop on the sterilised instruments or
Address correspondence and reprint requests to: Mr Ahmed Shawky Eid, Department of Orthopaedic Surgery, Yeovil Hospital,
Yeovil, Somerset, BA21 4AT, United Kingdom. E-mail: [email protected]
76
U Butt et al.
the open wound or through air-borne infection. We
assessed bacterial contamination of 20 eyeglasses
from surgeons.
MATERIALS AND METHODS
Between 16 and 23 November 2010, 40 samples were
taken from the nose pad (n=20) and earpiece (n=20)
of 20 eyeglasses from orthopaedic surgeons using
a sterile swab stick soaked in sterile distilled water.
Each sample was processed separately. On day one,
each swab was placed into a broth and incubated for
24 hours at 36ºC. On day 2, the broth was inoculated
onto 3 plates: Staphylococcus/Streptococcus agar
plate, Mannitol salt plate, and Chromogenic agar
plate. These plates were incubated at 36ºC aerobically
for 24 hours. Mannitol salt and Chromogenic agar
plates were read once more at 48 hours. Organisms
isolated were identified and saved using storage
beads.
RESULTS
Of 20 eyeglasses, 19 were contaminated with
Staphylococcus epidermidis (3 of them additionally grew
S haemolyticus or S xylosus) and the remaining one
grew S aureus. None of the eyeglasses was dropped
or touched by surgeons’ hands during surgery.
DISCUSSION
Infections following joint arthroplasty remain a
problem despite the use of antibiotics and identifying
the sources of bacterial contamination.7 In laminar
flow theatres, air-borne contamination can be reduced
significantly when the occlusive gowns, hats, and
masks are worn.8,9 The facial area of scrub staff is a
source of contamination in laminar airflow theatres,
and thus the use of exhaust helmets is recommend.10
Wearing of surgical (safety) eyeglasses reduces the
risk of eye splash injuries to surgeons.
Journal of Orthopaedic Surgery
As a normal skin commensal, S epidermidis is a
contaminant rather than a pathogen. Nonetheless,
it is a leading cause of nosocomial infections.11 The
risk of S epidermidis bacteraemia is high in neonates,
patients undergoing chemotherapy, and those
with in-dwelling medical devices.12–14 Formation of
biofilms on plastic devices is a major virulence factor
for S epidermidis, as surface proteins bind blood and
extracellular matrix proteins. The organism’s capsule,
known as polysaccharide intercellular adhesion layer,
is made up of sulphated polysaccharide. It enables
other bacteria to bind to the already existing biofilm,
creating a multilayer-biofilm. Such biofilms decrease
the metabolic activity of bacteria within them. This
decreased metabolism, in combination with impaired
diffusion of antibiotics, decreases the effectiveness of
antibiotics. Therefore, the most efficient treatment for
these infections is to remove or replace the involved
implant.15 This phenomenon most commonly occurs
on intravenous catheters and on in-dwelling medical
devices.16,17 S epidermidis is the leading cause of
orthopaedic prosthetic device infections.18 Prosthesis
removal is devastating; hence all attempts should be
made to prevent infection.
In our study, eyeglasses are a source of surgical
infection, harbouring considerable skin flora.
Contamination can be caused by falling of the
eyeglasses directly onto the wound, touching of
the eyeglasses accidentally by surgeons during
operation, or by splashes (from saline irrigation)
hitting the eyeglasses and falling back into the wound.
Moreover, eyeglasses can cause air-borne infection
through the laminar airflow system in operating
theatres. Therefore, disinfection should be performed
for eyeglasses of surgeons. The use of surgical visor
masks or filtered exhaust helmets (space suits) are
alternatives.
ACKNOWLEDGEMENTS
We thank Dr Susan Hardman and Ms Jill Morgan
from the Musgrove Park Hospital, Taunton for their
assistance.
REFERENCES
1. Lewis DA, Leaper DJ, Speller DC. Prevention of bacterial colonization of wounds at operation: comparison of iodineimpregnated (’Ioban’) drapes with conventional methods. J Hosp Infect 1984;5:431–7.
2. Leaper DJ, van Goor H, Reilly J, Petrosillo N, Geiss HK, Torres AJ, Berger A. Surgical site infection—a European perspective
of incidence and economic burden. Int Wound J 2004;1:247–73.
3. Lidwell OM. Air, antibiotics and sepsis in replacement joints. J Hosp Infect 1988;11(Suppl C):S18–40.
4. Davis N, Curry A, Gambhir AK, Panigrahi H, Walker CR, Wilkins EG, et al. Intraoperative bacterial contamination in
Vol. 20 No. 1, April 2012
Infection risk from surgeons’ eyeglasses
77
operations for joint replacement. J Bone Joint Surg Br 1999;81:886–9.
5. Ahmed SM, Ahmad R, Case R, Spencer RF. A study of microbial colonisation of orthopaedic tourniquets. Ann R Coll Surg
Engl 2009;91:131–4.
6. Cocciolone RA, Tristram S. Hewitt PM. Surgical masks: operative field contamination following visor-to-visor contact. ANZ
J Surg 2004;74:439–41.
7. Lidwell OM, Elson RA, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, et al. Ultraclean air and antibiotics for prevention of
postoperative infection. A multicenter study of 8,052 joint replacement operations. Acta Orthop Scand 1987;58:4–13.
8. Taylor GJ, Bannister GC. Infection and interposition between ultraclean air source and wound. J Bone Joint Surg Br
1993;75:503–4.
9. Lankester BJ, Bartlett GE, Garneti N, Blom AW, Bowker KE, Bannister GC. Direct measurement of bacterial penetration
through surgical gowns: a new method. J Hosp Infect 2002;50:281–5.
10. Owers KL, James E, Bannister GC. Source of bacterial shedding in laminar flow theatres. J Hosp Infect 2004;58:230–2.
11. Vuong C, Otto M. Staphylococcus epidermidis infections. Microbes Infect 2002;4:481–9.
12. Isaacs D, Australasian Study Group For Neonatal Infections. A ten-year, multicentre study of coagulase negative
staphylococcal infections in Australasian neonatal units. Arch Dis Child Fetal Neonatal Ed 2003;88:F89–93.
13. Winston DJ, Dudnick DV, Chapin M, Ho WG, Gale RP, Martin WJ. Coagulase-negative staphylococcal bacteremia in
patients receiving immunosuppressive therapy. Arch Intern Med 1983;143:32–6.
14. Ahn CY, Ko CY, Wagar EA, Wong RS, Shaw WW. Microbial evaluation: 139 implants removed from symptomatic patients.
Plast Reconstr Surg 1996;98:1225–9.
15. Salyers AA, Whitt DD. Bacterial pathogenesis: a molecular approach. 2nd ed. Washington, DC: ASM Press; 2002.
16. Otto M. Staphylococcus epidermidis—the ’accidental’ pathogen. Nat Rev Microbiol 2009;7:555–67.
17. Hedin G. Staphylococcus epidermidis—hospital epidemiology and the detection of methicillin resistance. Scand J Infect
Dis Suppl 1993;90:1–59.
18. Rupp ME, Archer GL. Coagulase-negative staphylococci: pathogens associated with medical progress. Clin Infect Dis
1994;19:231–45.