Analysis of corneal scrape outcomes in NHS Ayrshire and Arran

Abstract

Aims/Purpose: Corneal scrape is a key diagnostic procedure in the management of microbial keratitis. Safe technique for corneal scrape is a requirement of the Royal College of Ophthalmology (RCOphth) curriculum; national and international best practice guidelines exist (1, 2). The purpose of our project is to evaluate the local method of scraping in Ayrshire and Aran, Scotland. The primary aims of this project are to determine: the current method of corneal scraping, the yield of positive samples and impact on safe patient care.Methods: The corneal scrape samples submitted to microbiology from Ayr Casualty Clinic were analysed between 1st November 2021–19th December 2022. An audit was taken of the equipment available in clinical areas of the Ophthalmology department and the technique used by on‐call clinicians. Through liaising with microbiology, a local poster was created with guidelines for performing corneal scrape and placed in the eye casualty department with appropriate equipment set up.Results: There was large variation in the clinical technique used to perform the corneal scrapes. None of the on‐call clinicians were able to perform the technique to the published standard. There were no slides, agar plates or needles available for use. One third of clinicians described the correct technique but had no access to the correct equipment. Two‐thirds did not describe the correct technique. Twenty‐two samples were submitted between 01/11/2021–19/12/2022. All samples were cultured, however there were only two positive samples.Conclusions: Uncertainty and clinical variation exist in the clinical technique used to perform this key diagnostic procedure. There are no guidelines available in the casualty clinic or on‐call room and the necessary equipment is unavailable. The next steps include the creation of a local protocol with correct equipment available to improve the diagnostic yield.