Archive May 2018 XIX, No. 5

Infection Prevention

Rewriting the Rules of Cataract Reprocessing

JoEllen McBride

JoEllen McBride, PhD


Viewing Microscope
WET OR DRY If you're transporting sterilized instruments immediately to the OR, do they really need to be dry?

Intraocular instruments get a lot more use than endoscopes or laparoscopes, but they obviously don't get as heavily soiled with blood or bodily fluids because they're confined to the anterior segment of the eye. Yet some facilities are using outdated, impractical and even dangerous cleaning and sterilizing guidelines that were written for general surgical instruments, not for cataract instruments. Fortunately, a group of the world's leading cataract surgeons last month updated the specialty-specific reprocessing guidelines ( that address the unique challenges of cleaning and sterilizing ophthalmic instruments.

Some of the advice runs counter to what instrument IFUs specify and surveyors expect, but you'll find mounds of evidence-based reasoning that support why, for example, routine use of enzymatic detergents is not safe for intraocular instruments and short-cycle sterilization is. A few highlights:

1Routine use of enzymatic detergents is unnecessary
The first guideline states that if you thoroughly rinse intraocular surgical instruments with critical water promptly after each use, the routine use of enzyme detergents is unnecessary and should not be required for routine decontamination of intraocular instruments.

Inappropriate use or incomplete rinsing of enzymatic detergents has been associated with outbreaks of toxic anterior segment syndrome (TASS), yet some instrument instructions for use (IFU) say you should use enzymatic detergents to decontaminate cataract instruments after every use.

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