Disinfection of eyelid specula with chlorhexidine gluconate (Hibiclens) after examinations for retinopathy of prematurity

Background: The preferred method of cleaning eyelid specula between examina tions for retinopathy of prematurity is unknown. A previous study showed th at disinfection with 70% isopropyl alcohol swabs fails to eliminate viruses and bacteria from the specula. Objective: To determine if alternative sterilization procedures would allow multiple use of a single speculum without risking nosocomial infection. Methods: In phase 1, 40 autoclave-sterilized eyelid specula were randomized into either cleaned or "patient control" groups after being used for routi ne retinopathy of prematurity examinations performed in the outpatient sett ing. Specula in the cleaned group were cleaned with chlorhexidine gluconate (Hibiclens). Specula in the patient control group were not cleaned after u se. All study specula were placed into enriched culture media from which ba cterial and fungal cultures were obtained. In phase 2, 20 autoclave-sterili zed eyelid specula were inoculated with a clinically relevant dilution of a denovirus serovar 5 or herpes simplex type 2. Specula were randomized into either a cleaned or a control group, and cell cultures and immunofluorescen ce assays were used to document and confirm, respectively viral growth. Results: In phase 1, all 20 cultures from the patient control group grew ba cteria compared with 0 (0%) of 20 cultures from the cleaned group and 0 (0% ) of 5 from the cleaned control group. No fungi were isolated from any grou p. In phase 2, all 10 cultures from specula inoculated with adenovirus sero var 5 grew virus. None of the cultures from the 5 cleaned specula inoculate d with herpes simplex type 2 grew virus. In contrast, all 5 cultures in the control group were positive for growth of herpes simplex type 2. Conclusions: Autoclave sterilization is the ideal method of sterilization o f eyelid specula between neonate examinations. When an alternative disinfec tion technique is required, washing the speculum with chlorhexidine glucona te and tap water is preferred over wiping with a 70% isopropyl alcohol swab .