Highlights from the Ophthalmic Instrument Cleaning and Sterilization task force

Can you believe it’s only been 150 years or so that doctors started washing their hands before surgery? We’ve come a long way understanding the dangers of contamination during surgery. The guidelines from the Ophthalmic Instrument Cleaning and Sterilization task force updated the standards this year and can be found here.

Some highlights from the new guidelines include:

  • When cleaning intraocular instruments, thoroughly rinsing and flushing is important before the disinfecting or sterilization step.
  • Contaminated and soiled instruments should be cleaned in an area separate from where packaging and sterilization take place and ophthalmic instrumentation should be cleaned separately from non-ophthamic surgical instruments.
  • During decontamination and cleaning, all debris inclusive of ophthalmic viscosurgical device (OVD) should be removed from the instruments. It’s helpful to keep instruments moist until you’re able to begin the cleaning process to avoid the drying of debris and OVD.
  • Volume and type of water for cleaning and rinsing instruments should follow the manufacturer’s instructions for use (IFU). When flushing is used as part of a cleaning technique, be sure to minimize splash and aerosolization so that contaminated fluid isn’t spread.
  • Some offices discard cleaning syringes and brushes after each use but if brushes are reused, they should be cleaned and disinfected or sterilized at least once daily.
  • Instruments should be visually inspected for debris and damage after cleaning and before packaging for sterilization to ensure removal of debris.
  • Short-cycle sterilization used in accordance with the IFU of FDA-approved sterilizers is appropriate for routine use in between sequential same-day ophthalmic cases. While you can’t interrupt the sterilization process, you can interrupt the drying process if the instruments are used immediately and transported appropriately.

The new OICS guidelines state that if “intraocular surgical instruments are thoroughly rinsed with critical water promptly after each use, the routine use of enzyme detergents is unnecessary and should not be required for routine decontamination of ophthalmic intraocular instruments.” Enzymatic solution that remains on intraocular instruments is a leading cause of toxic anterior segment syndrome (TASS). However, many manufacturers’ instructions call for the use of enzymatic cleaners, the omission of which would therefore be considered off-label. Stay tuned for more developments on this topic.