Improving the Efficiency and the Technique of the Corneal Scrape Procedure via an Evidence Based Instructional Video at a Quaternary Referral Eye Hospital

ABSTRACT

Purpose: Corneal culturing requires understanding of aseptic non-touch technique and avoidance of possible contaminants. Currently, there is no formal training in the technique and registrars are typically taught by another registrar in the emergency setting.

The aim of the study was to develop an evidence-based instructional video for the corneal scrape procedure in microbial keratitis. The study then aims to assess the effect of the instructional video on clinician performance of the corneal scrape procedure.

Method: An instructional video for corneal scraping was developed by identifying key steps for the procedure based on available evidence from a review of the literature and clinical practice. A prospective observational comparative case series that included clinicians at the Sydney Hospital/Sydney Eye Hospital, NSW Australia was conducted. Clinicians performing corneal scrapes had their performance of the procedure assessed prior to and after viewing the instructional video.

Results: Sixteen key steps to follow in performing the corneal scrape procedure were found and demonstrated in the instructional video. Fourteen clinicians were observed performing 24 corneal scrapes in 24 patients with a median age of 56 years (IQR 34–65 years) and 45% male. Pre-video 11 scrapes were observed vs 13 scrapes post-video. Descriptive data were summarised and non-parametric categorical data analyzed using IBM SPSS (version 1.0.0.800) to perform chi-square and Wilcoxon signed-rank tests. Statistical significance was defined as p < .05. The steps of the corneal scrape procedure were performed correctly by a greater number of clinicians post-video compared to pre-video (p = .003). There was a significant improvement in inoculation of agar plates with cross-hatched streaks (92% post- vs 55% pre-video) and the maintenance of an intact agar surface (92% post vs 55% pre-video) (p = .033).

Conclusion: An instructional video optimized the performance of corneal scraping, by ophthalmology trainees, in patients with microbial keratitis.

KEYWORDS:

• Corneal scrape
• microbial keratitis
• corneal sample
• diagnosis

Conflict of interest

No conflicting relationship exists for any author.

Additional information

Funding

Stephanie Watson is supported by the Sydney Medical School Foundation. Pauline Khoo is supported by an Australian Government Training Program Scholarship from the University of Sydney, Australia and the Ophthalmology and Vision Science PhD Scholarship from the Sydney Eye Hospital Foundation.