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. 2020 Jun 5;9(7):7.
doi: 10.1167/tvst.9.7.7. eCollection 2020 Jun.

Microbial Cross-contamination in Multidose Eyedrops: The Impact of Instillation Angle and Bottle Geometry

Alexandre Xavier da Costa  1 , Maria Cecilia Zorat Yu  1 , Denise de Freitas  1 , Priscila Cardoso Cristovam  1 , Lauren C LaMonica  2 , Vagner Rogerio Dos Santos  1 , José Alvaro Pereira Gomes  1
Affiliations

Microbial Cross-contamination in Multidose Eyedrops: The Impact of Instillation Angle and Bottle Geometry

Alexandre Xavier da Costa et al. Transl Vis Sci Technol. .

Abstract

Purpose: To evaluate the impact of instillation angle and nozzle tip geometry on cross-contamination risk of multidose ocular solution bottles.

Methods: Pseudomonas aeruginosa solution was passed exclusively on the outside of the nozzle to simulate contamination on the exterior of topical agents. Three drops were administered from angles of 90° and 45° from bottles with either a round or sharp tip geometry, and the cultures were examined for growth. Two-hundred sixteen cultures from nine lubricant eyedrop brands currently existing in the Brazilian market were assessed for bacterial growth.

Results: After seven days, bacterial contamination was detected in 53.7% of cultures when drops were administered at 90° and in 70.4% of cultures at 45°. Eyedrops collected from a rounded nozzle tip and an instillation angle of 90° transmitted bacteria in 69.4% of cases, whereas those administered from a sharp tip transmitted bacteria in only 22.2% of cases (P = 0.001). At an instillation angle of 45°, contamination was identified in 83.3% of bottles with a rounded tip geometry and in only eight of 18 bottles (44.4%) from those with a sharp nozzle geometry (P = 0.005).

Conclusions: Adjusting the instillation angle of eyedrop solutions to 90°, as well as using a nozzle geometry that prevents flow of the solution to the side of the bottle, significantly reduced contamination rates.

Translational relevance: Standardizing drop bottles and adjusting delivery angle shows promise in reducing contamination rates and may critically impact the quality of care for patients requiring topical therapeutic agents.

Keywords: cross-contamination; drop instillation; eye drop standardization; eyedrops; ophthalmic solutions.

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Conflict of interest statement

Disclosure: A.X. da Costa, None; M.C.Z. Yu, None; D. de Freitas, None; P.C. Cristovam, None; L.C. LaMonica, None; V.R. dos Santos, None; J.A.P. Gomes, Allergan (C, E), MSD (C), Bausch & Lomb/Valeant (C, E), Mundipharma (C, E), EMS/Legrand (C), Shire (C), Alcon (E), Genom (E), Pfizer (E), Grin (E), Ofta Vision Health (E), FAPESP (R), Capes (R), Cnpq (R)

Figures

Figure 1.
Figure 1.
Detail of the formation of drops according to two types of eye drops bottles when inverted to 90° (A and B) and 45° (C and D). In a higher magnification, the geometry of the nozzle allows the eyedrop to contact a wider area of the outer face (E) or a narrow one (F).
Figure 2.
Figure 2.
Systane eyedrop formation at 90° and 45°.
See this image and copyright information in PMC

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