Outbreak of toxic anterior segment syndrome following cataract surgery associated with impurities in autoclave steam moisture.

Update item information
Publication Type Journal Article
School or College School of Medicine
Department Ophthalmology
Creator Mamalis, Nick; Nilson, Christian D.
Other Author Walter C. Hellinger; Saiyid A. Hasan; Laura P. Bacalis; Deborah M. Thornblom; Susan C. Beckmann; Carina Blackmore; Terri S. Forster; Jason F. Tirey; Mary J. Ross; Julia E. Crook; Rick E. Bendel; Rajesh Shetty; Michael W. Stewart; James P. Bolling; Henry F. Edelhauser
Title Outbreak of toxic anterior segment syndrome following cataract surgery associated with impurities in autoclave steam moisture.
Date 2006
Description BACKGROUND: Toxic anterior segment syndrome (TASS), a complication of cataract surgery, is a sterile inflammation of the anterior chamber of the eye. An outbreak of TASS was recognized at an outpatient surgical center and its affiliated hospital in December 2002. METHODS: Medical records of patients who underwent cataract surgery during the outbreak were reviewed, and surgical team members who participated in the operations were interviewed. Potential causes of TASS were identified and eliminated. Feedwater from autoclave steam generators and steam condensates were analyzed by use of spectroscopy and ion chromatography. RESULTS: During the outbreak, 8 (38%) of 21 cataract operations were complicated by TASS, compared with 2 (0.07%) of 2,713 operations performed from January 1996 through November 2002. Results of an initial investigation suggested that cataract surgical equipment may have been contaminated by suboptimal equipment reprocessing or as a result of personnel changes. The frequency of TASS decreased (1 of 44 cataract operations) after reassignment of personnel and revision of equipment reprocessing procedures. Further investigation identified the presence of impurities (eg, sulfates, copper, zinc, nickel, and silica) in autoclave steam moisture, which was attributed to improper maintenance of the autoclave steam generator in the outpatient surgical center. When impurities in autoclave steam moisture were eliminated, no cases of TASS were observed after more than 1,000 cataract operations. CONCLUSION: Suboptimal reprocessing of cataract surgical equipment may evolve over time in busy, multidisciplinary surgical centers. Clinically significant contamination of surgical equipment may result from inappropriate maintenance of steam sterilization systems. Standardization of protocols for reprocessing of cataract surgical equipment may prevent outbreaks of TASS and may be of assistance during outbreak investigations.
Type Text
Publisher University of Chicago Press
Volume 27
Issue 3
First Page 294
Last Page 298
Subject Toxic anterior segment syndrome; cataract surgery; autoclave steam moisture
Subject MESH Disease Outbreaks; Equipment Contamination; Water Pollution; Inflammation; Cataract Extraction
Language eng
Bibliographic Citation Hellinger WC, Hasan SA, Bacalis LP, Thornblom DM, Beckmann SC, Blackmore C, Forster TS, Tirey JF, Ross MJ, Nilson CD, Mamalis N, Crook JE, Bendel RE, Shetty R, JE, Bendel RE, Shetty R,, Edelhauser HF. (2006). Outbreak of toxic anterior segment syndrome following cataract surgery associated with impurities in autoclave steammoisture. Infect Control Hosp Epidemiol, 27(3), 294-8.
Rights Management © University of Chicago Press http://www.journals.uchicago.edu/loi/iche
Format Medium application/pdf
Identifier ir-main,12713
ARK ark:/87278/s61j9v8p
Setname ir_uspace
Date Created 2012-06-13
Date Modified 2012-06-13
ID 705385
Reference URL https://collections.lib.utah.edu/ark:/87278/s61j9v8p
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