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Background: Proper disposal of sharps in the clinical setting is a key factor in infection control. Previous research studies suggest that reprocessed, reusable medical devices and infectious waste containers are potential sources of microorganisms capable of causing infection in immunocompromised patients. This pilot study was a single-center, prospective, hospital-based, microbiologic evaluation of reusable sharps disposal containers returned to the hospital from a reprocessing company., Methods: A New England area, 130-bed community hospital performed the evaluation. Following delivery to the hospital's shipping/receiving area, 30 newly processed, reusable sharps disposal containers were swabbed for the presence of bacteria and viruses., Results: Twenty-seven containers (90%) tested positive for bacteria, and 10% of the recovered isolates were gram-negative rods. Nine out of 30 (30%) cultures were positive for viruses: HIV (10%), hepatitis A (6.7%), hepatitis B (6.7%), and hepatitis C (13.3%), and several containers tested positive for multiple viruses and bacteria., Conclusion: Reusable sharps containers were returned to this medical facility with bacterial and viral contamination. Further testing is warranted to determine the scope of the problem and potential clinical implications.

Purpose of Review: The aim of this article is to analyze the aspects related to the endotracheal tube which may influence the development of ventilator-associated pneumonia and to review the possible measures of prevention., Recent Findings: The endotracheal tube participates in the pathogenesis of ventilator-associated pneumonia by the elimination of natural defense mechanisms, thereby allowing the entry of bacteria by the aspiration of subglottic secretions or the formation of biofilm on the endotracheal tube. The preventive measures of ventilator-associated pneumonia related to the endotracheal tube include these two mechanisms. It has been suggested that substitution of the endotracheal tube by early tracheostomy may reduce the risk of ventilator-associated pneumonia., Summary: Aspiration of the subglottic secretions seems to be an effective measure with little risk; decontamination or exhaustive control of the sealing of the cuff has not demonstrated a positive risk/benefit balance. The causal relationship between biofilm and ventilator-associated pneumonia has not been clearly established. Treatment of the biofilm with antibiotics, changes in the composition of the endotracheal tube or mechanical cleansing have achieved a reduction or elimination of the biofilm but their effect on the incidence of ventilator-associated pneumonia has not been studied. The benefit of early tracheostomy in reducing ventilator-associated pneumonia is still controversial.

Objectives: To compare the mechanical and clinical performance of new and reprocessed harmonic scalpels (HS)., Methods: A total of 89 reprocessed and 90 new HS (laparoscopic coagulating shears with a curved blade and 5-mm-diameter shaft) were subjected to visual inspection, destructive testing, and nondestructive mechanical testing. Subsequently, new HS, randomly selected reprocessed HS, and selected reprocessed HS with known abnormalities were graded on clinical performance by 14 surgeons in a porcine model., Results: Visual inspection of the HS discriminated between the new and reprocessed instruments in 11 of the 12 visual criteria (P < or = 0.02). In vitro mechanical testing revealed greater clamp arm dislodge forces for the new HS (P < 0.01) and greater midshaft temperatures for reprocessed HS (P < 0.01). Overall, 65 (73%) of 89 reprocessed and 7 (7.8%) of 90 new HS had gross abnormalities noted on inspection and mechanical evaluation (P < 0.01). The surgeons' evaluation of the instruments during in vivo testing demonstrated that the new instruments manifested significantly greater hemostatic control compared with randomly selected reprocessed HS (P = 0.01) and were significantly better for tissue sticking (P = 0.01), tissue transection (P = 0.02), tissue dissection (P < 0.01), grasping (P < 0.01), and hemostatic control (P = 0.04) compared with reprocessed HS with obvious defects., Conclusions: In vitro and in vivo data demonstrated significantly greater performance for new HS compared with reprocessed HS. Mechanical testing of reprocessed HS could not adequately distinguish which HS would result in decreased performance. These findings raise important issues of clinical safety in the contemporary quest for cost-effectiveness.

Background: After Bacillus cereus recovery in opened boxes of disposable gloves, the bacteriological contamination of disposable nonsterile gloves kept stored in native packages was investigated prospectively., Methods: Thirty-six commercially available nonsterile nonpowdered disposable gloves made of latex, vinyl, or nitrile were cultured., Results: A large variety of spore-forming and non-spore-forming bacteria was recovered, including Bacillus cereus and Clostridium perfringens., Conclusion: This finding must be taken into consideration for care involving gloves in very immunocompromised patients.

Aim: Due to the theoretical possibility of prion transmission in applanation tonometry, many ophthalmological units in the United Kingdom now use disposable tonometer prisms. We have investigated the potential for bacterial and viral transmission from the health practitioner to the patient via disposable prisms., Methods: All staff who perform applanation tonometry at the Sussex Eye Hospital (SEH) received a questionnaire to evaluate if the applanating face of the prism is touched during tonometry and the ease of use of the disposable prism compared to the reusable prisms that were previously used. We then cultured prisms handled by a random sample of staff members for common bacteria. Finally, we constructed a model to investigate the possibility of interpatient adenoviral transmission via disposable tonometer prisms., Results: The questionnaire revealed that almost 50% of the staff admit to touching the applanating face of the tonometer prism prior to applanation. Cultures of the prisms grew a range of bacteria including Staphylococcus epidermidis, Staphylococcus aureus, and Bacillus species. The viral model suggested that adenovirus could be transmitted by applanation tonometry., Conclusion: The use of disposable prisms for applanation tonometry may reduce the risk of prion transmission but is not bacteriologically or virologically aseptic. This is a potential infection risk to patients.

Bacterial colony counts in water specimens from oxygen humidifiers that used reusable water reservoirs were compared with counts in water specimens from humidifiers that used prefilled disposable reservoir bottles to evaluate the effects of prolonged and multipatient use of humidifiers. Bacteria were detected after 1 week of operation in water specimens collected from many humidifiers with reusable reservoirs, but no bacteria were detected in water specimens from disposable bottles for up to 12 weeks during use of the humidifier by multiple patients.

Single-use surgical instruments have been used in the UK's ENT departments. This is in response to guidelines issued by the Department of Health and the British Association of Otolaryngologists and Head and Neck Surgeons, in order to prevent the spread of new variant Creutzfeldt-Jakob disease (vCJD) in a young population of patients undergoing routine adenotonsillectomy. In one institution we found that the new single-use instruments were inferior to previous standard kits and that postoperative haemorrhage rates had increased following children's tonsillectomy from 1.7% to 7.8% (p<0.01). Because of the increased reporting of complications following the use of single-use surgical instruments for adenotonsillectomies, ENT departments in the UK are no longer obliged to use these disposable instruments. This is due to the theoretical risk of prion infection being outweighed by the actual risk to the patient from increased postoperative haemorrhage.

Reprocessing of endoscopic instrumentation reduces the risk of transmitting infectious organisms to patients and health care workers. Health care workers should use the Bloodborne Pathogen Standard and Standard Precautions to determine the best method to reduce and/or eliminate bioburden.

Historically, inhaled placebos have been provided by pharmaceutical companies and have been widely used by nurses both in primary and secondary care to teach respiratory patients how to use prescribed inhaled therapy. Over recent years, the author of this article has had concerns about the potential risk of cross-infection as a result of reusing placebos with disposable mouthpieces. This concern has been heightened by the lack of verbal and written guidance from the pharmaceutical companies that provide these placebos. There are no recognized protocols or guidelines on the most effective cleaning methods that would minimize or prevent cross-infection. The cleaning of large volume spacers, which are used to enhance a patient's inhaler technique, are particularly problematic as it is not possible to use a disposable mouthpiece with this device. In response to this problem, a cross-sectional, multicentre, regional audit was designed to identify the decontamination process adopted by nurses working in the fields of respiratory care and infection control. The audit outcome confirmed that nurses were using a number of different cleaning methods, with no sound evidence base to support their chosen methods of decontamination. This is an issue that requires further investigation and clarification if nurses are to continue assessing patients' techniques with inhaled devices.

During the ten years that I have worked at the Canadian Nurses Protective Society, we have had numerous calls from Operating Room nurses questioning the practice of re-using single use medical devices in their facilities and voicing their concerns about possible harm to patients, themselves and potential liability exposure. Interest in this topic has been rekindled by the recent Saskatchewan case involving the death of a patient from variant Creutzfeld-Jakob Disease (vCJD) and possible transmission of vCJD to 71 patients who may have been exposed to the same endoscope as the deceased while in hospital. In this article, I propose to address some of the concerns related to the reuse of single use medical devices by focusing on the prevalence of this practice, the legal risks involved, regulation of this practice, and risk management.

Background: It has been suggested that single-use biopsy forceps prevent interpatient transmission of infection during endoscopy. Passage of sterile forceps through the accessory channel of the endoscope may lead to contamination, however, if the endoscope has been inadequately processed. The potential for contamination of single-use biopsy forceps at various stages of endoscope reprocessing was prospectively evaluated., Methods: A total of 50 disposable biopsy forceps were passed through the accessory channels of 10 colonoscopes at the following stages of reprocessing: (1) before use in patients to establish a baseline of high-level disinfection, (2) directly after colonoscopy to confirm contamination with use, (3) after manual cleaning and flushing of the accessory channel to support the claim that manual cleaning significantly decreases bioburden, (4) after manual cleaning and a 2-minute soak in 2% glutaraldehyde to assess for contamination after an inadequate cleaning time, and (5) after manual cleaning and a 20-minute soak in 2% glutaraldehyde. The forceps were then sealed in sterile plastic bags after adding 20 mL of thioglycollate broth medium. The suspension was passed through a 0.2-micron vacuum filter and the filters were cultured. All cultures were incubated more than 48 hours., Results: Biopsy forceps underwent a total of 50 aerobic and 50 anaerobic cultures. Colony-forming units too numerous to count of GI flora, including Escherichia coli, Klebsiella, Pseudomonas, and Clostridium species, grew on 19 of 20 culture plates from biopsy forceps passed through colonoscopes immediately after use. One plate in this group grew 3 colony-forming units of E coli. Persistence of GI flora was noted on 5 of 20 plates after manual cleaning of the colonoscopes. No GI flora were found on forceps after the colonoscopes after soaking in gluteraldehyde for 2 and 20 minutes. Environmental contaminants including diptheroids, Staphylococcus, and Streptococcus species grew on 16 culture plates., Conclusions: (1) Single-use biopsy forceps are highly susceptible to contamination during passage through the accessory channels of improperly cleaned endoscopes. (2) Disinfection of the colonoscopes in this study prevented contamination of the forceps at baseline and after reprocessing. (3) Proper endoscope reprocessing may be the most important factor in preventing biopsy forceps-related interpatient infection.

Aim: To determine the prevalence of Burkholderia cepacia from the environment in a regional adult cystic fibrosis (CF) care centre., Methods: Two hundred and eighty-five environmental samples were taken from inpatient and outpatient environments within the CF centre. Following a non-selective enrichment step, broths were plated onto a selective medium and B. cepacia isolates were confirmed by phenotypic tests and also genotypically by species specific 16S rRNA PCR., Results: B. cepacia was not detected from commonly shared items of equipment, staff hands, staff uniforms or toilets. In addition, the organism was not detected in toilet bowls, even in the B. cepacia unit. With regard to positive environments for B. cepacia, 4/10 (40%) of the outside surfaces and inner rims of patients' plastic disposable sputum collection containers and 4/17 (23.5%) of air from patients' rooms, following physiotherapy, were positive., Conclusions: All positive samples originated in the B. cepacia segregation area of the inpatient wards and B. cepacia was not detected in the non-cepacia area of the CF centre. Consequently, these two positive sites should therefore be treated as high risk, where organisms may be potentially transmitted from environment to patient. As there is now evidence to suggest differences in the virulence and hence clinical outcome of certain of the genomovars of this organism, this study may be important in highlighting the areas that patients who are B. cepacia positive should avoid, to minimise the risk of transmission and acquisition of this organism within the CF cepacia population. These results indicate that effective infection control procedures are required in patients' rooms following physiotherapy, for prevention of B. cepacia transmission and to avoid the transmission of different genomovar types within CF patients, who are already colonised with this pathogen.

There is a paucity of data on the penetration of bacteria through surgical gowns during operations. A simple new method was developed, using Petri dishes filled with horse blood agar that were attached to the outside of the gown material. This was used to assess bacterial penetration through disposable spun-bonded polyester gowns and re-usable woven polyester gowns during normal use. There was a significant difference between the two gown types when tested in the axilla (P = 0.02), the groin (P = 0.02) and the peri-anal region (P < 0.01), with the disposable gowns performing to a higher standard. Re-usable gowns demonstrated variation in penetrability, and for this reason, may be unsuitable for use in orthopaedic implant surgery., (Copyright 2002 The Hospital Infection Society.)

This paper outlines the development of Bovine Spongiform Encephalopathy (BSE) in the United Kingdom. The relationship between BSE and new variant Creutzfeldt-Jakob disease (vCJD) is considered and the risks of iatrogenic spread reviewed. The rationale for disposable surgical instruments in adenotonsillectomy to prevent iatrogenic spread is discussed.

Objective: The frequency of bacteriuria is high in children with neurogenic bladder on intermittent catheterization for bladder emptying. In an effort to decrease bacteriuria, we examined whether the method of catheter care was responsible for the high rate of bacteriuria. For this, the frequency of bacteriuria was examined in the same patient on single-use sterile catheters and on reused clean catheters., Methods: A prospective, randomized, crossover trial was conducted with 10 patients who were randomized to 4 months of a new, sterile catheter for intermittent catheterization and 4 months of reuse of a clean catheter for intermittent catheterization. Each week, a urine sample was collected and symptoms of infection and medication use were recorded., Results: A total of 158 urine samples were collected during 164 patient-weeks on the new catheter method for each void; 115 (73%) were positive for a pathogen. Of the 161 samples collected during 169 patient-weeks on the standard, reuse method for voiding, 123 (76%) were positive (115 [73%] of 158 vs 123 [76%] of 161). Escherichia coli was the most common pathogen detected during both method periods., Conclusion: A new, sterile catheter for each void did not decrease the high frequency of bacteriuria in patients with neurogenic bladder on intermittent catheterization.

Financial pressures imposed on hospitals by health maintenance organizations and insurers have prompted investigation into alternative procedures that reduce expenses while maintaining the high standards required for patient care. Although not necessarily mutually exclusive, these dual agendas pose a challenge for endoscopy managers charged with balancing the risks and benefits of reusable and disposable endoscopy instruments. Our endoscopy unit elected to evaluate the feasibility of reducing costs by using reprocessed single-use devices. Following the selection of a third party reprocessor and prior to using any reprocessed devices in the clinical setting, our facility decided to submit single use devices that had been used once for reprocessing and then have an independent laboratory test them for sterility. Although we followed a thorough, multi-disciplinary approach, our end result led us to conclude that the cleaning, reprocessing, and resterilization of single-use biopsy forceps and snares is a greater challenge than previously anticipated. Reprocessing of the single-use devices tested did not result in endoscopic instruments that met acceptable standards for sterility at our institution.

The cleaning of flexible endoscopes is difficult and time consuming. Any method of attempted sterilization or high level disinfection will fail if prior cleaning has been defective. Inadequate reprocessing of endoscopes may result in patient to patient transmission of serious bacterial and viral diseases or infection with endemic hospital pathogens. Antibiotic prophylaxis is required to prevent septicemia and bacterial endocarditis in high risk patients undergoing specific endoscopic procedures. Prevention of serious endoscopy-associated clinical infections requires strict compliance with detailed reprocessing protocols by specially trained nursing staff.

Purpose: To report the first case of fungal keratitis in a patient wearing daily disposable soft contact lenses., Methods: Case Report. A 20-year-old white female in good health developed a corneal ulcer in her lefteye associated with daily disposable soft contact lens wear. There was no history of trauma to the left eye, and she denied overnight wear. Corneal scrapings were taken, and the patient was started on intensive tobramycin 14 mg/mL and cefazolin 50 mg/mL topical therapy for suspected bacterial keratitis. After 3 days of antibacterial therapy, the ulcer worsened. The cultures were negative as were the Gram stain and Gomori's methenamine silver stain. Initial cultures and stains were then repeated with the addition of a culture for herpes simplex virus. The developing clinical picture was suspicious for fungal keratitis. The patient was then started on intensive vancomycin 2%, natamycin 5%, and continued on fortified tobramycin. Three days after the second corneal scrapings were performed, a positive fungal culture was obtained for Fusarium sp. Vancomycin and tobramycin were then discontinued and amphotericin B 0.15% was added to natamycin 5% with the continuation of intensive topical therapy., Results: The patient's keratitis was successfully treated with intensive double antifungal therapy., Conclusions: Infectious keratitis in daily disposable soft contact lens wear is an unusual occurrence. To our knowledge, there is no previous case of fungal keratitis occurring in patients wearing daily disposable lenses. This case emphasizes the importance of considering fungus in the differential diagnosis for keratitis even in daily disposable contact lens wearers.

The lack of regulation and procedures to monitor the reuse of single-use devices (SUDs) is allowing the use of medical devices that can pose a risk to patient health. Studies on reused SUDs show a range of defects. Despite this, uncontrolled reuse of SUDs continues. This article explores the extent of the problem, reports the findings of some of the studies and suggests what should be done.

The studies conducted sought to estimate contamination of contact lens (CL) storage cases and commercial solutions with Pseudomonas aeruginosa as well as to investigate everyday sources, which the CL wearer uses or comes into contact with. The studies revealed that 13. 1% of storage lens cases and 5.1% of commercial solutions in use were positive for the bacterium. Ten hermetically sealed CL solutions were tested for possible contamination, but these all proved to be sterile. In addition, environmental samples, of both a solid and liquid nature, yielded relatively high contamination rates with this opportunistic bacterium. Results showed that common sources, which the CL wearer is in contact with, possess P. aeruginosa and this may indeed predispose to corneal infections., (Copyright 2000 S. Karger AG, Basel)

Objective: The aim of this study was to determine whether changing heat and moisture exchangers (HMEs) every 96 hrs rather than 24 hrs would affect their efficacy to preserve the heat and moisture of inspiratory gases. The impact of a prolonged use of the HME on its microbial colonization was also assessed., Design: Prospective cohort observational study., Setting: Intensive care unit of a university hospital., Patients: Thirteen consecutive patients with no previous history of respiratory disease requiring controlled mechanical ventilation with an HME for >4 days were evaluated., Interventions: The same HME was used for 96 hrs in each patient., Measurements and Main Results: In each patient, during the inspiration phase, the following measurements were performed: peak and mean airway pressures, mean values of temperature, and relative and absolute humidity of inspired gases. In each patient, measurements were performed after 1 hr of HME use and then daily up to the fourth day. On days 1 and 4, microbiological samples were obtained from the patients' bronchial secretions and the ventilator side of the HME. After 96 hrs of ventilation with the same HME, tracheal tube occlusion was never observed. Using the same HME for 96 hrs rather than 24 hrs did not affect its technical performances: temperature at 24 hrs: 32.2 +/- 1.5 degrees C (90.0 +/- 34.7 degrees F), at 96 hrs: 32.1 +/- 1.6 degrees C (89.8 +/- 34.9 degrees F); relative humidity at 24 hrs: 97.9 +/- 2%, at 96 hrs: 98.1 +/- 1.7%; absolute humidity at 24 hrs: 33.1 +/- 2.4 mg H2O/L, at 96 hrs: 33.0 +/- 2.5 mg H2O/L. This analysis was based on a total of 312 measurements performed on the 13 patients. Peak and mean airway pressures did not change during the 96-hr study period, with identical tidal and minute volumes in the study patients. On day 1, ten patients had a positive culture of their tracheal secretions at a colony count of > or = 10(3) colony forming units/mL. After 96 hrs of use with the same HME, only seven patients had a positive culture of their tracheal secretions. Cultures from the ventilator sides of the HMEs were all sterile (13/13) after 96 hrs of use., Conclusions: In patients free from previous chronic respiratory disorder and ventilated for neurologic reasons, changing the HME after 96 hrs rather than 24 hrs did not affect its technical performance in terms of heat and water preservation of ventilatory gases. There is also some indirect evidence of very little, if any, changes in the HME resistance. No bacterial colonization of the ventilator sides of the HMEs was observed after 96 hrs of use. However, other large clinical trials should be undertaken to confirm the safety of extending the time between HME changes.

The cost of mechanical ventilation (MV) is high. Efforts to reduce this cost, as long as they are not detrimental for the patients, are needed. MV with heat and moisture exchangers (HME) changed every 48 h is safe, efficient, and cost-effective. Preliminary reports suggest that the life span of these filters may be prolonged. We determined prospectively whether a hygroscopic and hydrophobic HME (Hygrobac-Dar; Mallinckrodt) provided safe and efficient heating and humidification of the inspired gases when changed only once a week. Patients who were considered to require mechanical ventilation for more than 48 h were included in the study. HMEs were initially set for 7 d. Efficient airway heating and humidification were assessed by clinical parameters (number of tracheal suctionings and instillations required, peak airway pressures) and hygrometric measurements performed by psychrometry. Resistance was measured from Day 0 to Day 7. Bacterial colonization of circuits and HMEs was studied. A total of 377 days of mechanical ventilation with 60 HMEs was studied. Clinical parameters and hygrometric measurements did not change between Day 0 and Day 7. Mean absolute humidity was 30.3 +/- 1.3 mg H(2)O/L on Day 0 and 30.8 +/- 1.5 mg H(2)O/L on Day 7 (p = 0.7). Endotracheal tube occlusion never occurred. Three HMEs were replaced prematurely because of insufficient absolute humidity. This rare event occurred only in patients with COPD and after the third day of use. In addition, the absolute humidity delivered by the HMEs was significantly lower in patients with COPD than in the rest of the population. Resistance did not change from Day 0 to Day 7 (2.4 +/- 0.3 versus 2.7 +/- 0.3 cm H(2)O/L/s; p = 0.4). Bacterial samples of both circuits and ventilator sides of HMEs were sterile in most cases. We conclude that mechanical ventilation can be safely conducted in non-COPD patients using an HME changed only once a week, leading to substantial cost savings (about $110,000 per year if these findings were applied to the university-affiliated hospitals in Paris).

Purpose: To evaluate the bacterial contamination of bandage disposable soft contact lenses used in patients following photorefractive keratectomy (PRK) and to correlate our findings with clinical data., Methods: Forty-six patients (81 eyes) underwent PRK. Immediately after each procedure, disposable soft contact lenses were positioned with sterile forceps. After 3 days, the lenses were removed in a sterile manner, placed in sterile Eppendorf pipettes containing 8 mL of enriched brain heart infusion broth, and analyzed for microbial contamination., Results: Seven positive cultures were found: six gram positive cocci (7.4%) and one gram negative bacillus (1.2%). There was no clinical correlation with these findings., Conclusion: Isolated microorganisms were similar to those described in the literature as agents of bacterial keratitis and are components of the normal ocular flora. Klebsiela pneumoniae--considered an occasional or transient flora--was the exception. All isolated microorganisms but K. pneumoniae were sensitive to most of the antibiotics tested. Our findings suggest that the risk of infectious keratitis after PRK related to soft contact lens wear for 3 days seems to be low, which may be because lenses were not manipulated by the patient during the wearing period, and the postoperative antibiotic regimen was strictly followed by patients. However, care should be taken to instruct patients in proper lens care practices to reduce the risk of bacterial keratitis in contact lens wear following PRK.

The relationship between surface contamination (cfus/m2/h) with particles carrying aerobic bacteria and corresponding air contamination rates (cfus/m3) was evaluated in operating rooms (OR) equipped with ultra clean vertical or horizontal laminar airflow (LAF). For the evaluation we collected data during strictly standardized sham operations using non-woven disposable or cotton clothing. Air contamination in the wound and instrument areas (Casella slit sampler) was related to the surface contamination rate (settle plates) in the same areas and in addition, on the patient chest. Typically, the mean surface counts were 20-70 cfus/m2/h and the air counts 1-2 cfus/m3 in disposable clothing experiments, whilst the use of cotton clothing resulted in higher counts of 100-200 cfus/m2/h (wound P > 0.05, patient P > 0.05, instruments P < 0.01) and 4 cfus/m3 (P < 0.02-0.001). In the vertical LAF, taking both disposable and cotton clothing operations together, the surface and air contamination rates (surface/air ratio SAR) were highly correlated (P = 0.02-0.004) and the ratio varied between 18:1 and 50:1 with a mean for wound air of 36:1. Using only disposable clothing in the vertical LAF, the number of significant correlations was reduced. With cotton clothing experiments in vertical LAF and in the horizontal LAF using disposable clothing, no significant correlation between surface and air contamination was found. The wide variation of SAR values and the inconsistent relationship between surface and air counts indicates that measurement of OR air contamination represents an unhelpful method for assessment of surgical site contamination in LAF units. We propose instead that colony counts on sedimentation plates is a clinically more relevant indicator of bacterial OR contamination in LAF units. In addition to the current bacteriological standard for ultra clean OR air of (< 10 cfus/m3) we suggest a corresponding standard for the surface contamination rate of < 350 cfus/m2/h.

Purpose: To describe a case of bilateral corneal ulcers caused by Pseudomonas in a disposable soft contact lens wearer. This case study discusses the role of patient examination, contact lens care instruction, and adequate patient supervision in reducing the risk of serious potential complications., Methods and Results: A 17 year old student who had been using disposable soft contact lenses on an extended wear basis for 6 months presented complaining of pain in the left eye. When he was examined, a corneal ulcer with surrounding infiltrate was observed in the superior middle periphery of the left eye. Samples were collected for culture, and treatment with fortified cefalotin and gentamicin was started. After 8 hours the patient returned, now complaining of pain in the right eye. Examination of the right eye revealed a diffused keratitis with a mucopurulent discharge. A culture was taken, and the same treatment was instituted. The laboratory tests revealed Pseudomonas in both eyes. The bilateral corneal ulcers responded to therapy after 1 week of treatment., Conclusions: We discuss the factors involved in the occurrence of infectious keratitis in contact lens wearers, and stress that even disposable contact lens wear can be associated with serious complications. This case also highlights extended wear as one of the main risk factors for complications in disposable soft contact lens wear.

Presterilized (disposable) syringes and needles were subjected to sterility testing for aerobic cultures. It was found that 56.3% of the samples were contaminated indicating failure of the sterilisation process. The implications of this could be far reaching and is discussed alongwith.

The reusability of disposable plastic trocars after high-level disinfection by alkalinized 2% glutaraldehyde solution was examined in a prospective study from the point of view of infection risk in order to determine the safety and economic benefits. For this purpose, 45 laparoscopic cholecystectomy cases were analyzed microbiologically and clinically. In 30 cases, trocars subjected to 15 min of disinfection by glutaraldehyde were used. In the remaining 15 cases, new trocars were used and a control group was established. In total, eight culture samples were taken from trocars, laparoscope (as it is disinfected by the same method), glutaraldehyde solution and umbilicus of the patients preoperatively; and from the bile in the gallbladder, peritoneal lavage fluid, and epigastric and umbilical incisions postoperatively. Only one of the disinfected trocars yielded a culture-positive result. No culture-positive results were found in the samples taken from laparoscope, glutaraldehyde, and epigastric incisions. Culture-positive results were obtained in 11 cases at the umbilicus, in one case at the peritoneal lavage and in one case at the umbilical incision. None of the patients had infection at the wound site or intra-abdominally. In conclusion, we have shown that disposable plastic trocars subjected to high-level disinfection can be reused safely without infection risk and that cost can be reduced.