Abstract
Purpose: :
To identify the level of adherence to the recommendations of the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study of the prophylaxis of endophthalmitis after cataract surgery in the National Health Service in the UK (NHS) and to explore the possible causes for non- adherence.
Methods: :
We conducted a telephone survey of Ophthalmology units within the NHS. Theatre managers and/ or theatre scrub nurses routinely involved in cataract surgery where contacted and responses were recorded in a pre-set proforma.Primary question was: Do you use Intra- cameral Cefuroxime (1.0 mg/ 0.1 ml normal saline) routinely peri-operatively as the standard unit protocol as per ESCRS recommendations? If the answer was no, further questions directed to explore causes and other methods of prophylaxis against endophthalmitis
Results: :
We surveyed 73 ophthalmology units in the NHS. We found that 53 units (72.6%) use a standard protocol with 29/ 73 units (39.7%) use Intra- cameral Cefuroxime (1.0 mg/ 0.1 ml normal saline); 23 units (31.5%) use only sub-conjunctival Cefuroxime and one unit only (1.36%) use intra-cameral Vancomycin. There were 20 units (27.3%) with variable practices between consultants with 18 (90%) of them use intra-cameral Cefuroxime as a part of its practices. Others practices include sub-conjunctival Cefuroxime, topical Chloramphenicol and Vancomycin in irrigation solution.Reasons for non-adherence include: no specific reason in 59% of the surveyed units; satisfaction with current outcome in 20.4%; differences in opinions in 9.0%; concerns of safety in 2.2%; pharmaceutical difficulties (4.5%), lack of evidence (2.2%) and use only in complicated cases (2.2%).
Conclusions: :
Our survey shows that ESCRS recommendations are not widely applied within the NHS despite the Royal College of Ophthalmologists' professional guidance, updated on June 2007. Satisfaction with current outcome is an important cause. However, no apparent managerial cause was identified in the majority of the units.
Keywords: endophthalmitis • cataract • antibiotics/antifungals/antiparasitics