The Ophthalmic Instrument Cleaning and Sterilization Task Force released guidelines for the cleaning and sterilization of intraocular surgical instruments in ASCs.
Here are five key insights.
1. The OICS is made up of representatives of the American Society of Cataract and Refractive Surgery, the American Academy of Ophthalmology and the Outpatient Ophthalmic Surgery Society
2. The guidelines are an update of original recommended practices published in 2007. They were developed specifically for cataract surgery, but many recommendations are made with respect to all surgical procedures.
3. The most common risk factors for Toxic Anterior Segment Syndrome included inadequate flushing and rinsing of handpieces, use of enzyme detergents and use of ultrasonic baths, according to an analysis cited in the report.
4. Many of the task force's recommendations were derived from evidence-based recommendations for cleaning and sterilizing all surgical instruments in general, published analyses of TASS outbreaks and manufacturers' instructions for use.
The recommendations for facilities include the following:
- Establish written protocols for instrument cleaning and sterilization based on industry standards and guidelines, with input from the nursing and medical staff.
- Thoroughly train personnel in handling, cleaning and sterilizing intraocular surgical instruments and implement periodic oversight.
- Do not routinely require enzymatic detergents for intraocular instruments, as they "might unnecessarily elevate the risk for TASS without providing significant benefit to the patient." Follow proper dilution and disposal procedures if enzyme detergents are used for any reason.
- Remove all visible soil before placing instruments in an ultrasonic cleaner, which should be emptied, cleaned, disinfected, rinsed and dried at least once a day.
- Allow cataract surgeons to use clinical observations and judgment in determining whether to reuse phaco tips off-label
- Reduce environmental emissions by minimizing material use, reusing or reprocessing surgical materials, purchasing "environmentally preferred" supplies, reducing energy consumption, safely increasing efficiency of OR turnover and optimizing surgical and central sterile processes.
5. The task force also found "many practices mandated by regulatory and licensing agencies might not have a proven benefit for ocular surgery and therefore might not justify the significantly higher cost and carbon footprint they entail."
