Do Antibiotics Mask the Risk Of Infection from Flashing?
Re: "What's Wrong With Flashing Cataract Instruments?" (July, page 54). On page 56 of this article, a manager of a Missouri ASC says, "The surgical site infection rates do not support AORN's statement at all." If this ASC's patients don't receive prophylactic antibiotics before cataract surgery, then this nurse's point may be valid. But if patients are routinely treated pre-surgically with prophylactic antibiotics, then this nurse's point — and the argument's linchpin that flashing isn't associated with an increased risk of infection — is potentially misleading. Could it be that flashing is associated with an increased risk of infection, but that these infections are hidden and killed by the antibiotics, thereby masking and preventing the identification of an increased risk of infection associated with flashing ophthalmic (and other types of surgical) instruments?

This question about prophylactic antibiotics and its answer are part and parcel to any discussion about the risk of infection associated with flashing ophthalmic instruments. Nevertheless, it's rarely discussed in articles about this topic. I think not to address this issue is a potential oversight.

Before such conclusions as this Missouri manager's can result in a change in practice favoring routine flashing, controlled studies need to be done and referenced involving flashed ophthalmic instrument sets with one group of cataract patients receiving prophylactic antibiotics while the other does not. I believe such a study is possible and would be deemed medically ethical.

This type of study might reveal a significant difference between the infection rates associated with these two groups, suggesting a possible increased risk associated with flashing. To contend, if not argue, that flashing doesn't pose an increased risk of infection without discussing other relevant factors — such as whether patients were treated pre-surgically with antibiotics — is to miss the point, possibly subordinate patient safety and suggest erroneously that a potentially unsafe practice is without risk.

Lawrence F. Muscarella, PhD
Editor-in-Chief
The Q-Net Monthly
editor@myendosite.com