A microscopic analysis of single-use versus multi-use phacoemulsification tubing in maintaining sterility and patient safety

Abstract

Background: The Pietermaritzburg (PMB) complex in South Africa does not have a uniform protocol regarding reuse of phacoemulsification tubing. Each hospital in the complex has its own guideline, based on manufacturer recommendation and cost-saving measures. There is no definitive scientific evidence proving that reusing phaco tubing will harm patients.

Aim: To assess if phacoemulsification tubing remains sterile during sequential phacoemulsification.

Setting: The study was conducted at Edendale Hospital and Greys Hospital in PMB. Greys Hospital has a single-use policy and at Edendale policy, multi-use of tubings is allowed.

Methods: This was an observational descriptive prospective study observed over 4 months. Routine phacoemulsification was carried out at each hospital as per hospital guidelines. At the end of the surgery, the tips of the tubing were cut off, placed in a standard specimen container and sent to the laboratory for culture and microscopy. Results were compared and two unused tubings were also analysed as controls.

Results: A total of 26 single-use tubings were analysed and it was found that 46.2% grew no organisms; 19.2% grew Bacillus species; other microorganisms were in less than 1% of tubings. A total of 41 multiple-use tubings were sent for analysis. Forty one and a half percent grew no organisms; 17.1% tubings grew Bacillus species. Other microorganisms were found in less than 5% of tubings. Unused tubings did not grow any microorganism.

Conclusion: A p value less than 0.05% was accepted as statistically significant. Comparing the two hospitals, tubings which grew no organisms were 46.2% (single-use) versus 41.5% (multiple-use). This gives a statistically non-significant p value of 0.70. Tubings which grew Bacillus species were 19.2% (single-use) versus 17.1% (multiple-use) (p = 0.83). Other microorganisms also showed a p value of 0.76. This implies that phacoemulsification tubing is significantly contaminated after just one use. Although no statistical difference was found between the two groups, a contamination rate of over 40% is of great concern. There are contributing factors which may have influenced this result. In our setting, phaco tubing does not seem to remain sterile after cataract surgery. Further research needs to be carried out in order to gain more insight into patient safety.