Recommended Practices for Cleaning & Sterilizing Intraocular Surgical Instruments

Intraocular surgery requires the use of small and intricately designed instruments that must be sterilized with the proper procedures to ensure patients are protected from germs and bacteria. Failure to follow these procedures as directed by the American Society of Cataract and Refractive Surgery can potentially result in patient illness and blindness. These recommended practices should be used in conjunction with the most current guidelines from the Association for the Advancement of Medical Instrumentation, the American Society of Ophthalmic Registered Nurses and the Association of periOperative Registered Nurses.

Instruments

• All opened instruments must be kept moistened in a closed container until transported from the operating room to the decontamination room; the instruments should then be cleaned immediately. Throughout the procedure, wipe instruments with damp cloths free of lint. Carefully handle all equipment; avoid bending that may result in misalignment of the tools. Clean then flush lumens in the decontamination room. Flush only with sterile water directly into the drain to effectively remove residue. Dry all instruments with lumens with filtered compressed air free of oil and water. Single-use disposable cannulas and tubing should be discarded following the procedure. The phacoemulsifier hand piece, irrigator and aspirator, should be wiped down with a damp cloth free of lint. Remember to include the tips and inserter lenses while wiping. Flush the phacoemulsifier hand piece with balanced saline solution prior to removing it from the operating room at the end of the procedure. Place the instruments in a bath of sterile water and remove them from the operative field into the decontamination room. Rinse with sterile distilled or deionized water through and over instruments into the drain so used water is discarded. Instruments should be dried with filtered compressed air.

Ultrasonic Cleaners

• Identify instruments that should not be placed in the ultrasonic cleaner by consulting the manufacturer's directions for use. Clean the ultrasonic cleaner with an EPA-registered disinfectant then rinse with sterile or tap water prior to placing instruments inside for cleaning. The machine should be emptied, cleaned, rinsed and dried after each use. It should be run with no instruments inside once before it is filled again. Seventy percent to 90 percent ethyl or isopropyl alcohol is recommended for the final rinse. The machine should be dried using a cloth free of lint.

Manual Cleaning Guidelines

• Only use brushes that have been designated for cleaning intraocular instruments.

  Consult the manufacturer's directions for use to determine the appropriate types of brushes to use for every instrument. Ideally, brushes should be discarded after they are used. If this isn't an available option, bring them into the decontamination room for sterilization, disinfection and cleaning. Wipe down the instruments with 70 percent to 90 percent ethyl or isopropyl alcohol, look for any remaining debris or damage using magnification, then begin assembling and packing the instruments for sterilization. Follow all manufacturers' directions for use to perform and complete the process of steam sterilization.