科研之友
微信
新浪微博
Facebook
分享链接
摘要
Objective: The Goldmann applanation tonometer presents the problem of being one of the most widely used pieces of equipment in the ophthalmic clinic and a known risk factor for the transmission of epidemic keratoconjunctivitis (EKC). The purpose of this review is to assess the effectiveness of 3 methods of disinfection: alcohol swabs, immersion in peroxide, and the use of disposable prisms. An economic evaluation is undertaken to assess the cost-effectiveness of the 3 alternatives. In doing so, we contribute an evidence-based overview of the issue at an opportune time, because several jurisdictions are developing protocols regarding tonometer tip disinfection. Design: Systematic review and cost-effectiveness analysis. Methods: A comprehensive literature review was undertaken with a librarian, comprising searches of 6 electronic databases and hand searches of the grey literature. A 3-level screening process was undertaken by 2 reviewers according to prespecified inclusion and exclusion criteria. Values from included papers were used to inform a cost-effectiveness analysis undertaken using a decision tree model implemented in TreeAge. The analysis was undertaken from the hospital perspective and included all equipment and labour costs. Results: Synthesis of in vitro data indicates that all 3 methods are plausible methods of disinfection with a 64% reduction in log growth of EKC when peroxide is used compared with alcohol swabs. The incremental cost-effective ratios from the cost-effectiveness analysis were $12 000/case averted using peroxide and $61 000/case averted with Tonosafe as compared with alcohol. Conclusions: Assuming clinical infection rates match in vitro disinfection data, the cost of bleach is high and the cost of Tonosafe is unacceptably high to reduce 1 potential case of adenoviral keratoconjunctivitis.
- 出版日期2014-8
