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DM Perrigin, RL Boltz, AE Katzenberger, JA Perrigin; Strategies to Decrease the Frequency of Staphylococcus Aureus Contamination of Diagnostic Ocular Pharmaceuticals . Invest. Ophthalmol. Vis. Sci. 2002;43(13):44.
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Purpose: Studies have previously shown that bottle tips and the inside surface of caps of diagnostic pharmaceuticals in clinical use may become contaminated with bacteria. This study investigated two methods for their potential to decrease the risk of contamination of drops dispensed from bottles with contaminated tips: a wash-out experiment and an ethyl alcohol wipe experiment. Method: Staphylococcus aureus bacteria were inoculated onto the tips of 20 new, unexpired bottles of 1% tropicamide ophthalmic solution and 20 bottles of 0.5% proparacaine hydrochloride ophthalmic solution. Washout experiment: Two drops from each of 10 bottles of proparacaine and tropicamide were dripped onto 5% sheepsblood agar plates. The tip, inside of the cap, and the contents of each bottle were also cultured. Alcohol wipe experiment: One drop from each of 10 bottles of proparacaine and tropicamide was dripped onto 5% sheepsblood agar. The tips of the bottles were wiped with a 70% ethyl alcohol pad and then wiped with a dry tissue. Two drops were then dripped onto the sheepsblood agar. Results: Washout experiment: All specimens showed growth too numerous to count in both the first and second drops, on the bottle tips and inside the caps. In contrast, the bottle contents obtained by sterile aspiration showed no growth. Alcohol wipe experiment: The alcohol wipe reduced the incidence of contaminated bottles to 50% and 25% for the first and second drops of proparacaine, respectively. It reduced the incidence of contamination to 30% for the first and second drops of tropicamide. Conclusion: Discarding the first drop from heavily contaminated bottle tips of the diagnostic pharmaceuticals tested was not effective in reducing the chances that a contaminated drop would be instilled in a patient's eye. However, wiping the tips of bottles with an alcohol swab followed by a wipe with a dry tissue decreased the frequency of contamination of drops by at least 50% for proparacaine and 70% for tropicamide.
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