Use of nonsterile instruments for examination for retinopathy of prematurity in the neonatal intensive care unit

OBJECTIVE: Use of nonsterile eyelid speculae and scleral depressors during screening examinations for retinopathy of prematurity (ROP) in the neonatal intensive care unit (NICU) violates existing infection control recommendations. The objective of this study was to characterize current instrument management and to estimate the prevalence of use of nonsterile instruments. STUDY DESIGN: NICU nurse managers were surveyed. Questionnaires were mailed to 735 NICUs from The United States Neonatologists and Perinatologists Directory. RESULTS: Of 300 surveys returned, 290 reported ROP examinations in their NICUs. Two hundred ten (72%) of 290 NICUs reported supplying instruments. Seventy-five (36%) of 210 NICUs supplying instruments reported a best practice on the basis of current guidelines. Twenty-six (9%) of 290 NICUs reported eye infections as a result of ROP examinations. Reported infection was more frequent (19%) among NICUs reporting reuse of instruments ( P =.019) and more frequent (17%) among NICUs in which ophthalmologists brought their own instruments ( P =.021). Only one (2%) NICU reporting best practice also reported eye infections ( P =.004). CONCLUSIONS: ROP instrument management is inconsistent within and between NICUs. Without the exclusive use of sterile instruments, an increased risk of nosocomial infection might exist. Greater attention to sterile instrument management is recommended.