The Surgical Microbiome: A Narrative Review of Interdisciplinary Strategies for Infection Prevention in Ocular and Regional Anesthesia
Abstract
Background: Surgical site infections (SSIs) and peri-neural infections following ocular and regional anesthesia are devastating, albeit rare, complications. Traditional prevention strategies often focus on isolated factors—patient skin prep or surgical technique—while neglecting the interconnected "surgical microbiome": the complex ecosystem comprising the patient's endogenous flora, the healthcare environment, and the medications introduced into sterile spaces. A siloed approach fails to address the multifactorial pathways of contamination.
Aim: This narrative review aims to synthesize evidence to propose an integrated, microbiology-informed framework for infection prevention.
Methods: A systematic search of PubMed, Scopus, Web of Science, and CINAHL was conducted for literature published between 2010 and 2024.
Results: The review identifies four critical, interdependent vectors of risk: 1) Environmental Reservoirs in phacoemulsification and anesthesia equipment; 2) Pharmaceutical Vectors from non-sterile compounded solutions; 3) Procedural Breaches during regional block administration; and 4) Surveillance Gaps in linking infections to their source. Evidence supports routine environmental culturing, mandatory use of USP <797>-compliant pharmacy compounding, standardized aseptic draping for blocks, and informatics-driven outbreak detection.
Conclusion: Infection prevention requires reconceptualizing the OR as a single microbiological continuum. An interdisciplinary strategy, uniting the laboratory, pharmacy, anesthesia technology, nursing, and informatics, is essential to mitigate risk. Proactive, system-wide vigilance over the entire surgical ecosystem—from the pharmacy cleanroom to the patient's eye—is the cornerstone of safeguarding vision and neurological function in modern anesthesia and surgery.
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Copyright (c) 2024 Danah Othman Almazyad, Tahani Obaid Sheeqa Almutairi, Sami Saeed Alrashdi, Saleem Nawar Saleem Alboaqami, Hani Ghazi Abdulmalik, Rawan Rashed Omar Alharthi, Abdulmajed Awidh Almutiri, Bandar Mohammed Abdullah Al-Duhaymi, Laila Abdullah Alnasser, Abdulrahman Ali Alsugaihe, Saeed Ahmed Alghamdi, Rayan Abdulrahman Almugarry
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