Seeing Eye to Eye: Reprocessing of Eye Devices

Eye devices are too often overlooked and not being correctly cleaned, disinfected, or sterilized. To discuss this topic, Infection Control Today^® (ICT^®) spoke with Katharine J Hoffman, MPH, CIC, infection preventionist, JPS Health Network, Fort Worth, Texas; and Lisa Waldowski, DNP, RN, CIC, regional director of Infection Prevention & Control, Kaiser Permanente, the Association for Professionals in Infection Control and Epidemiology (APIC) 2022 Annual Conference, held June 13-15, 2022, in Indianapolis, Indiana. Hoffman and Waldowski discussed their presentation titled “Don't Lose Sight: Intentionally Approaching Eye Device Reprocessing.” In addition, they wrote the following article exclusively for ICT^® readers.

Multiple eye devices in health care settings that touch the eye are reused on patients without being appropriately cleaned, high-level disinfected, or sterilized according to the specific device manufacturer’s instructions for use (MIFUs). Outbreaks associated with eye devices have occurred due to lack of cleaning, incorrect cleaning, or failure to high-level disinfect (HLD) or sterilize the eye device between patient use in neonatal intensive care units (NICUs), eye care clinics, and operating rooms (ORs).

Where are eye devices located?

Urgent care clinics (UCCs), emergency departments (EDs), NICUs, eye care clinics, ORs, and ambulatory surgery centers (ASCs).

Who uses eye devices?

Optometrists, Ophthalmologists, ED/Trauma physicians, and Ophthalmic surgeons.

What are some examples of eye devices?

Tonopens, ocular gonioscopes, A/B scan probes, Yag laser lenses, and eye specula.

Eye Device Manufacturer’s Instructions for use (MIFUs).

Many eye device MIFUs are not readily available, are outdated, or are not read and followed when it pertains to cleaning, high-level disinfection, and sterilization instructions. Eye device MIFUs should be reviewed and supported by central sterile processing, infection prevention and control, the respective manager, and end user of the device. Ideally, eye device MIFUs should be a component of a device/products analysis team before purchasing the device to assure that cleaning, disinfection, and sterilization instructions can be adhered to.

Eye Device High-level Disinfection (HLD) or Sterilization Opportunities

Eye devices that touch the eye according to the Spaulding Classification System, would be considered a semi-critical or critical device based on intended use, therefore, requiring minimally HLD or sterilization.Eye device MIFUs state the recommended HLD or sterilization requirements. What is frequently noted is that eye devices are being cleaned with either soap and water or a low-level disinfecting wipe in the patient exam room and allowed to air dry on a paper towel before next use. Required next steps of transporting the eye device to central sterile processing for HLD or sterilization never occur. Precleaning steps if noted by the manufacturer, or based on selected HLD or sterilization guidelines, and appropriate means of transport to central sterile processing are typically not known or implemented. Additionally, re-usable eye devices have been noted to be stored in their original wooden box, which is not only uncleanable storage containment, but also likely to be contaminated over time.

Recommendations

• Obtain an inventory of all eye devices in your organization
• Obtain current MIFUs for all eye devices. Have central electronic access for all key stakeholders to use MIFUs (central sterile processing department, infection prevention department, managers, physicians, frontline staff)
• Consider single-use disposable eye device options
• Follow eye device manufacturer’s MIFUs for cleaning, HLD, or sterilization
• Include eye devices in the Infection Prevention and Control Risk Assessment
• Include eye devices in HLD and sterilization process rounding/audits
• Assure key stakeholders are competent, trained, and educated based on their role in the reprocessing of eye devices (frontline staff, central sterile processing, infection prevention, and managerial oversight)
• Audit this process across settings for standardization as appropriate

Infection prevention and control has yet another opportunity to lay eyes on and validate evidence-based, manufacturer supported eye device HLD and sterilization reprocessing. Like other re-usable medical equipment and devices, omissions of HLD and sterilization reprocessing pose a significant risk to patient safety.