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    4 steps to care for ophthalmic instruments

    Take care of your tools so they take care of you

    Proper care and handling of ophthalmic instruments is essential in decreasing the risk of healthcare-acquired infections. Whether instruments are processed in clinic, surgery, or a surgical center, the same critical steps apply: cleaning/decontamination, sterilization, quality control, and storage. Each step plays an important role in infection prevention. Below are some guidelines to help guide you through each step.

    1. Cleaning/decontamination

    The cleaning of instruments should begin immediately during the procedure to prevent drying of blood, soil and debris on the surface and within lumens. Debris that remains on instruments can block the sterilizing agent from making complete contact with the surface.

    Manual cleaning includes wiping instruments clean using a sterile, water-moistened sponge. A soft toothbrush can also be used to clean instruments. Instruments with lumens should be flushed with distilled water followed by compressed air. About 120 cc of fluid is recommended.

    More from iTech: How to create a happy patient

    If you are using mechanical cleaning, such as an ultrasonic cleaner, the water in the ultrasonic cleaner should not exceed 140°F/60°C. Prior to exposing instruments to the ultrasonic cleaner, instruments should be completely opened or disassembled in order to expose all parts of the instrument. Needle holders, forceps, and scissors must be completely opened to clean inside the jaws. Key characteristics of a cleaning agent are:

    • Low sudsing/foaming  

    • Biodegradable

    • Easily rinsed off   

    • Non-abrasive

    • Disperse organic soil 

    • Non-toxic

    Cleaning solution should be mixed with measured amounts of water and detergent—do not guess. To decrease the risk of toxic anterior segment syndrome (TASS), do not expose lumens to detergent. Instruments must be thoroughly rinsed with copious amounts of water, distilled water preferred, for adequate removal of detergent. If rinse volumes are specified, the volume represents the minimum volume. If you are using tap water for rinsing, be sure it is compatible with the manufacturer’s recommendations for detergent and equipment. Always follow the manufacturer’s recommendation for the care and handling of each instrument and the instructions for use of the ultrasonic cleaners.

    More from iTech: Clinic safety: Incidents, medication, and consent

    For stiff instruments, lubricant can be used. Lubricant is recommended for hinged instruments only, such as scissors, needle holders, and forceps. Lubricant prevents the development of stiff joints and inhibits the development of corrosion. The instruments are dipped, one by one, into the lubricant; do not soak instruments in lubricant or expose lubricant to instruments containing a lumen.

    Before storing instruments, be sure they are thoroughly dried. Instruments stored wet or damp will rust.

    Next: Sterilization

    Lori Pacheco, RN, CRNO
    Lori Pachco is clinical director of Cape Cod Eye Surgery and Laser Center in Sandwich, MA.

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