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Sahar Kohanim, Jeanie Ling, Sarah Tanaka; Effect of a simple intervention in reducing rates of corneal ulceration due to exposure keratopathy in the ICU. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3789.
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Untreated exposure keratopathy is a preventable cause of corneal ulceration in critically ill patients. We have previously described rates and risk factors for exposure keratopathy. The purpose of this study was to determine if an educational intervention for ICU staff could reduce rates of exposure-related corneal ulceration in the trauma ICU.
This quality improvement project was deemed "exempt" by the Vanderbilt IRB. Our educational intervention consisted of a one-time lecture to ICU nurses about exposure-related corneal ulceration, how to identify it, and implementing a protocol for aggressive eye lubrication in patients at risk. Posters were also placed in the ICU with this information. Rates of exposure keratopathy were assessed by trained examiners on 3 separate days prior to the intervention and again on 3 days approximately 1 month post-intervention. Eyes of each patient were graded for degree of lagophthalmos (1-completely closed, 2-conjunctival exposure, 3-corneal exposure). The number of cases of exposure-related corneal ulceration was determined based on review of ophthalmology consultation notes over the 6 months preceding the intervention, and were compared to the number of cases in the 6 months following the intervention.
Pre-intervention, a total of 29 patients were examined in the trauma ICU over 3 days. 22 patients (75.7%) showed grade 1, 3 (10.3%) showed grade 2, and 4 (13.8%) showed grade 3 exposure. Post-intervention, of the total of 18 patients examined, 13 (72.2%) showed grade 1 closure, 0 showed grade 2, and 5 (22.2%) showed grade 3 closure. Thus, the rates of exposure remained stable. However, because of the educational intervention related to the need to recognize and aggressively lubricate eyes with exposure, the number of cases of exposure-related corneal ulceration was reduced from 14 cases in the pre-intervention 6 month period to only 4 cases in the 6-month period following the educational intervention (71.4% reduction).
A single educational intervention with lecture and follow-up posters in the ICU appears to reduce rates of corneal ulceration associated with exposure keratopathy over the 6 months following the intervention. Longer term follow-up is needed to assess the durability of this improvement, to determine the frequency with which refresher educational interventions might be needed.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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