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Surgeons need higher awareness of cleaning systems and allow more time, resources
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CHICAGO — Surgeons must be aware of the cleaning systems in place in their surgical facilities and, must allow for increased time and resources to fend off infections that might result from improper cleaning procedures, a registered nurse said here.
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"There are a number of possible causes for TASS, but I can tell you that I've been on 31 site visits in the last 2 years and, in 100% of those facilities, there have been issues in instrument cleaning," Sue Clouser, RN, MSN, CRNO, spoke to a standing room only crowd at the annual American Cataract and Refractive Surgery meeting.
Most surgeons are not aware of the instrument cleaning process of the facilities in which they operate, according to Ms. Clouser.
"You have a high degree of dependence on your staff to bring you instruments that are clean and sterilized and safe to use on your patients ," she said.
Ms. Clouser said the problems often begin when a new instrument is purchased and the manufacturer's directions for use are not retained.
"Many facilities are not following the manufacturer's directions for cleaning and that's probably their first major problem," she said. She recommended that all manufacturer's instructions are followed and retained for future reference.
In the operating room, recently used instruments must be thoroughly wiped down, not by using "the swish method," which will not remove the viscoelastic that must be removed prior to drying.
"That is not instrument cleaning," Ms. Clouser said. "Different types of instruments require different types of care."
Non-cannulated instruments require mechanical cleaning with a soft brush while phacoemulsification and irrigation and aspiration handpieces and tips need flushing, as directed by the manufacturer.
"Trying to clean one of those I&A tips can be extremely time-consuming and extremely difficult and it takes a lot of time to do it properly," she said. "If you've got a lot of cases going and you have one person trying to use a 60 cc syringe to flush through those handpieces, it is extremely difficult."
Ms. Clouser did suggest that there are some automated systems, such as the QuickRinse system (American Optisurgical).
"The new technology is toward a smaller incision. Everybody's trying to do it through a smaller opening and a smaller cartridge but that requires the instrumentation to shrink and accommodate the smaller wounds," she said. "This means the instrumentation will be more fragile, more easily damaged and certainly more difficult to clean."
Ms. Clouser also touched on disposable instruments and warned that they are not meant to be reused.
"You have to reuse them at your own risk and certainly reuse will void any warranty the manufacture would offer you," she said.
"I think we have a responsibility to our patients ... to do the best job that we can for our patients. This may mean that you need to purchase more instruments, allow more time for cleaning and sterilizations or increase the number of personnel, all of which are going to cost you money but, in the long run, probably less money than a big TASS outbreak at your facility," Ms. Clouser said.