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Hi Robyn,
We were in a similar predicament some time ago. The work around looks very similar to the procedures that we adopted, although because of the potential for the thermal disinfection rinse (at the time not supplied with RO water) to increase the endo toxin level, we did not use an Automated Washer Disinfector.
We did designate one ultrasonic as “Eyes only”, this was drained and filled degassed with each cycle. It was also dosed with an non enzymatic neutral detergent rather than the enzymatic, used in the other machines. In the literature some authors have suggested a link between enzyme residue and TASS.
The other important process change was to designate the top shelf of the drying cupboard as “eyes only” and ramp up the cleaning of the drying cupboard. The reasoning behind this was that the drying cupboard was primarily used for “hand washed instruments” and on several occasions I observed orthopaedic/cardiac drills and saws above dripping onto eye sets
We also introduced a “priority process” for eye sets to avoid wet sets sitting for long periods and in the packing area avoid potential contamination prior to packing. Any sets that were not wrapped with in four hours of washing were sent back for reprocessing.
For the most part the written procedure referenced the manufacturers IFU (many having manual cleaning options at the time) and we produced a step by step, pictorial laminated “how to”guide. One common problem we had was operators not fully understanding the role of the sterile rinse water. On several occasions I found them decanting sterile water into un-sterile bowls as well as reusing irrigation syringes (Phaco equipment). This was after an education program and competency check.
Kind regards
Ken
Ken Chapman
BNurs/BAppSc(HealthProm), PG cert Ed, MAqua
Infection Prevention and Control Clinical Coordinator
Cabrini Health
________________________________
Dear ACIPC members
I would greatly appreciate feedback from anyone more familiar than me with requirements for eye surgery instrument processing.
We are to commence basic surgery soon and do not have RO water at present albeit on the list as a must have sooner rather than later.
Our central sterilising unit have proposed a workaround as below as a risk mitigation strategy acknowledging it is not gold standard practice.
Would you accept this process as an alternative??
The suggested cleaning processes at Redland Hospital for eye instruments requiring HSO approval are as follows;
The Washer Disinfectors have an established validated eye cycle in place effective from February 2020
* Neutral Enzymatic chemical for the cleaning process
* Thermal disinfection
* Additional rinse phases during the validated cycle
* Removal of rinsing chemicals to avoid any residual on instruments
* Manually rinse individual instruments immediately following the validated cleaning cycle with 1 litre bottled sterile water to replicate the RO water final rinsing of the instruments
* Protein detection test of instruments
* Place instrument trays into the validated dryers
Infection Control will also initiate infection surveillance as it is a new procedure at our facility as well.
Appreciate any thoughts
Best wishes
Robyn
Robyn Birch
MAdv Prac IP&C, CICP
CNC Infection Control
Redland Hospital
Department of Health | Queensland Government
PO Box 585, ClevelandQLD 4163
t. (07) 3488 3518
m. 0412 585 099
Robyn.Birch@health.qld.gov.au | http://www.health.qld.gov.au
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