and surveyors expect, but you'll find mounds of evidence-based rea-
soning that support why, for example, routine use of enzymatic
detergents is not safe for intraocular instruments and short-cycle ster-
ilization is. A few highlights:
Routine 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 instru-
ments after every use.
"We are not aware of any study showing that enzyme detergent for
intraocular instruments reduces the rate of endophthalmitis," reads
the guideline. "Lacking proven efficacy for endophthalmitis
prevention, enzymatic detergents might unnecessarily elevate the risk
for TASS without providing significant benefit to the patient."
Enzymatic residue is notoriously difficult to rinse from instruments
and the guideline notes that these detergents typically contain
subtilisin or alpha amylase exotoxins, neither of which is denatured
by autoclave sterilization. Even small amounts left on instruments are
potentially toxic to the interior of the eye. You can usually remove the
minimal bioburden that forms on intraocular instruments during eye
surgery with a prompt and thorough rinsing with critical water, says
ophthalmologist David F. Chang, MD, of Los Altos, Calif., who co-
chaired the task force that created the guidelines.
1
M A Y 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 2 5
