Detailed recommendations on the cleaning and sterilizing of eye care surgical instruments can be found at the American Society of Cataract and Refractive Surgery as well as the American Society of Ophthalmic Registered Nurses. To begin with, there are some general principles to be followed.
Post surgery, the instruments will have to be kept a bit moist to prevent debris from hardening on them. Each instrument will have to be manually cleaned of debris visible according to the manufacturer’s directions for use (DFU). In the case of most instruments, the use of distilled or sterile deionized water for cleaning and rinsing is recommended.
When using an ultrasonic cleaner, you have to first ensure that all visible debris has been manually removed. Before you place the instruments in the cleaning tank, ensure that each of them has been approved by their respective DFU for ultrasonic cleaning. It is important that an ultrasonic cleaner, specific to medical instruments be used. The proportion of the cleaning solution used has to be as per the manufacturer’s recommendations. The solution will need to be suitably degassed before the instruments are placed in.
Once degassed, place the instruments in the solutions and set the timer as per DFU. At this stage high frequency waves pass through the solution resulting in an expansion (rarefaction) and contraction of the liquid. Microscopic bubbles are formed during the expansion process which ‘pop’ when they are compressed, releasing a stream of liquid energy that effectively dislodges the contaminants off the instrument’s surface. This strong localized stream of energy is very effective in cleaning the medical instrument of all debris. In some cases, multiple rounds of cleaning may be necessary depending on the stubbornness of the debris. Care also should be taken to ensure that the temperature does not rise above 40 degrees centigrade especially if you are cleaning instruments that have blood on them. Blood congeals into albumin above 40 degrees and will be virtually impossible to remove as it practically ‘fuses’ with the object’s surface.
Following this, the instruments should be sterilized in an autoclave or through any other prescribed methods of sterilization.
Once the cleaning process is done, the ultrasonic cleaner will have to be cleaned and sterilized as recommended. Ideally this should be done after every use, however once a day is permissible. The cleaning process has to be done with EPA approved solutions as well as methodologies. Once done, a thorough rinsing in sterile in sterile or tap water is necessary. Depending on the manufacturer, a final rinse in ethyl or isopropyl alcohol with a concentration varying between 70% and 90% is needed as well. The cleaning apparatus has to be completely dry and only then refilled.
The importance of cleanliness and sterilization could not be more evident than in the medical field. Ultrasonic cleaners ensure micron sized contaminants are removed which otherwise may get missed during manual cleaning. Generally each health care facility has its own set of rules and regulations regarding the cleaning and sterilization of surgical instruments. And the most important of all is to allow sufficient time for all these procedures to be carried out.