New Recommendations for Ambulatory Surgery Centers Cleaning Intraocular Surgical Instruments With Enzyme Detergent

By on 6:53 AM

The American Academy of Ophthalmology (AAO), American Society of Cataract & Refractive Surgery (ASCRS) and Ophthalmic Outpatient Surgery Society (OOSS) have published clinical guidelines for ambulatory surgery centers (ASCs) concerning the use of enzyme detergents to clean intraocular surgical instruments.

The societies convened to develop the guidelines, which can be accessed here, following increased reports of Centers for Medicare & Medicaid Services (CMS) surveyors enforcing the use of enzymatic cleaners, according to an EyeWorld report.

Inappropriate use or incomplete rinsing of enzymatic detergents has been associated with outbreaks of toxic anterior segment syndrome (TASS) in ASCs.

The guidelines state, "Based on the documented risk of TASS associated with enzyme detergent use, without proven benefit for endophthalmitis prevention, enzymatic detergent should not be required for routine decontamination of ophthalmic intraocular instruments."

The recommendation goes against some manufacturer's instructions for use (IFU) for the cleaning of contaminated intraocular instruments. If ASCs elect to continue to use enzymatic cleaners, the guidelines recommend the following: "... instructions for proper dilution and disposal of cleaning solutions should be followed. The instruments should be thoroughly rinsed to ensure removal of all detergent. Because tap water may contain heat-stable endotoxin from gram negative bacteria found in the municipal water supply, sterile distilled or sterile deionized water should be used for the final instrument rinse."

If you have been surveyed and advised to use enzymatic cleaners for your intraocular instruments, have questions about these new guidelines or other recommendations and rules for ASC infection prevention, contact Infection Control Consulting Services (ICCS). ICCS provides comprehensive infection prevention services, including development of customized infection prevention programs, infection prevention risk assessment, and corrective plans of action; infection prevention training; and accreditation preparation.

Phenelle Segal, RN, CIC, FAPIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS). Phenelle has more than 30 years' experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes and other organizations with implementing and maintaining an infection control program that: complies with The Joint Commission, AAAHC, Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies; respond to situations of noncompliance; and improve the processes for reducing risk.