Chemical disinfectants in ophthalmic practice

[Postoperative bacterial endophthalmitis: Differential diagnosis and confirmation]

Postoperative endophthalmitis is a bacterial infection that most often occurs acutely a few days after surgery. Any postoperative inflammation should raise the suspicion of acute endophthalmitis, especially if vitritis is present. Suspicion of the diagnosis must be combined with emergent therapeutic management in order to improve the anatomical and functional prognosis. The differential diagnoses are toxic anterior/posterior segment syndrome, phacoantigenic uveitis and inflammation of mechanical origin linked to implant malposition. Each entity requires its own specific treatment.

Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management

In this review we discuss the role of intraocular surgery preoperative prophylaxis. The correct choice of antimicrobial drug is variable in each surgical setting, according to the available strengths of evidence, the anatomical district involved, and the type of procedure. In the ophthalmic surgical field, there has been a progressive shift from antibiotic formulations, which are known to cause antibiotic resistance, to a new class of antiseptic compounds, which proved to be effective not only against bacteria, but also against fungi, protozoa, and viruses. Among these, povidone-iodine (PVI) is a water-soluble polymer that can form a complex with iodine, and the perioperative application of PVI 5-10% eye drop for 3 min is the gold standard for infection prophylaxis. A new formulation of 0.6% PVI eye drop is a new option for infection prophylaxis in the days before surgery. Chlorhexidine is a biguanide compound, which is a valid alternative with a good safety and efficacy profile and is the antiseptic of choice in patients with iodine allergy. New compounds that are currently being studied include polyhexamethylene biguanide (PHMB), picloxydine, ozone, hypochlorous acid (HOCl), and Biosecur. PHMB is a biguanide polymer that was found to be more effective than PVI in in vitro studies for reducing microorganisms and extending the duration of antisepsis, but to date, there are no formulations available on the market for preoperative ocular surgery in which it is present as main ingredient. Ozone is a molecule with oxidizing effect, which showed interesting preliminary results but is not effective against virus, Staphylococcus aureus and Candida albicans. HOCl has a natural bactericidal propriety but its applicability to prophylaxis of ocular infection in the setting of ocular surgery is not established. Biosecur is a non-toxic organic alcohol-free compound that exhibited bactericidal and fungicidal effect versus all common microorganisms and is currently available as an ocular spray.

Ozonated water in disinfection of hospital instrument table

Purpose

The walls, ceiling, and floor of a surgical environment, as well as the surfaces used in this place, must be submitted to a disinfection protocol to minimize nosocomial infections. Health regulations recommend two stages; the first is characterized by cleaning procedures, mainly using an enzymatic detergent, and the second is use of a disinfection agent. Ozone is a natural substance that has a relevant oxidative property for inactivating microorganisms and has emerged as an interesting agent in the hospital environment. Compared with conventional chemical products for disinfection, ozonated water has advantages such as a lack of storage control, disposal, and handling safety. The objective of this study was to use ozonated water as a disinfectant agent on a hospital metal surface, in comparison with 70% alcohol.

Methods

The degree of disinfection of the metal surface was quantitatively analyzed with use of an instrument by bioluminescence for a disinfection test.

Results

Qualitative terms indicated gram-positive cocci microorganisms and yeasts, suggesting that bacteria and fungi from the environment were identified. After the use of ozonated water as a disinfectant, the quantitative analysis indicated values below 100 RLU, showing evidence of a surface suitable for use in surgical procedures.

Conclusion

The use of ozonated water as a disinfectant agent for a metal surface in a hospital environment showed more effectiveness than 70% alcohol. Thus, ozonated water is a promising agent for disinfecting surfaces in surgical environments.

Screening of Staphylococcus aureus for Disinfection Evaluation and Transcriptome Analysis of High Tolerance to Chlorine-Containing Disinfectants

The nonstandard use of disinfectants can lead to the disinfectant resistance of bacteria and even increase antibiotic resistance. However, compared with the study of antibiotic resistance, studies of bacterial resistance to disinfectants are relatively few in number. In this study, we explored the standard strain screening procedure for the evaluation of disinfection efficacy. Staphylococcus aureus strains with different sources and substrates were selected from the National Pathogen Resource Center of China and screened the standard strains that could evaluate the long-term bacteriostatic effect of the chlorine-containing disinfectants through the determination of the physical properties, genome-based safety evaluation, and disinfection test evaluation. In this process, one S. aureus strain was more resistant to the long-term bacteriostasis of chlorine-containing disinfectants than the other strains. This strain and the standard strain ATCC 6538 were cultured in the medium containing a low concentration of chlorine-containing disinfectant synchronously. Then, comparative transcriptome analysis was carried out to investigate the potential mechanism of a high tolerance to chlorine-containing disinfectants. The pathway of significant differential expression is related to the oxocarboxylic acid metabolic mechanism, amino acid metabolic mechanism, and pyrimidine mechanism, which may be the molecular mechanism of S. aureus evolution to adapt to chlorine-containing disinfectants. Our study established a technical process for screening and evaluating standard strains for disinfection, which also provided a reference for studying the bacterial evolution mechanism toward chlorine tolerance.