Table 3 Recommendations for cleaning and sterilizing intraocular surgical instruments modified from the guideline proposed by ASCRS, AAO and ASORN [44]

Ensure adequate time for thorough cleaning and sterilization of instrument

•Rigorous adherence to recommended procedures for cleaning and sterilization

•Sufficient inventory of instruments to meet surgical volume and to provide adequate time for cleaning and sterilization

Follow manufacturer’s directions for use for cleaning and sterilization

Ophthalmic viscosurgical device solutions should not be allowed to dry on instruments

•Instruments should be rinsed with sterile water immediately following the use

Used instruments should be transported from the operating room in a closed container to the decontamination area

Whenever possible, use disposable instruments and/or tubing and then discard after each use.

•Do not reuse devices labeled for single use only.

Clean intraocular instruments separately from non-intraocular surgical instruments.

Avoid using enzymatic detergents for the cleaning of intraocular instruments.

•When the use of enzymatic detergents is necessary, instruments should be thoroughly rinsed with copious volumes of water to remove all detergent.

Ultrasonic cleaners should be emptied, cleaned, disinfected, rinsed and dried at least daily and preferably after each use.

Do not reuse manual cleaning tools unless designed for reuse.

•If brushes are reused, they should be designed for reuse and cleaned and treated with high-level disinfection or sterilization, preferably after each use, or at least once daily.

Rinsing should provide flow of water through or over instruments and agitation in a basin of water should not be used.

•Following thorough rinsing, instruments with lumens should be dried with forced or compressed air.

If reusable woven materials are used for draping or wrapping trays or instruments, they should be laundered thoroughly between each use to eliminate surgical compounds, debris, and cleaning agents.

Cleanliness and integrity of instruments should be verified.

Sterilization

•Glutaraldehyde is not recommended because of the toxicity of glutaraldehyde residues.

•Low temperature methods of sterilization should not be used unless validated by the instrument manufacturer.

•Regular autoclave sterilizers are preferred over Statim™ sterilizers because higher temperatures up to 190 °C can be reached.

•Verification of sterilizer function should be completed at least weekly, preferably daily.

Have a written policy in place for protocols for what happens to the instruments prior to and after each case in accordance with the manufacturer’s instructions.