sterile processing
sterile processing
By Tony Thurmond, CRCST, CIS, CHL, FCS
TASS: What It Is and How SPD Can Help Prevent It
Toxic anterior segment syndrome( TASS) is a rare, inflammatory condition of the eye that develops within 12 to 48 hours of an ophthalmic procedure, typically after cataract removals, penetrating keratoplasties, intravitreal anti-vascular endothelial growth factor( anti-VEGF) injections, and vitreoretinal surgeries. The condition affects the eye’ s inner lining and presents with or without pain and is marked by a decrease in or blurry vision, extreme sensitivity to light and severe inflammation.
Untreated TASS may lead to permanent eye damage or vision loss. An estimated 28 million cataract procedures are performed each year, with 15 percent( or 4.2 million) completed in the U. S. It is roughly estimated that one in a thousand cataract patients will develop TASS. This article addressed how the condition is believed to develop and sterile processing( SP) professionals’ essential role in helping prevent its occurrence.
TASS risk factors
Studies have identified several strong possibilities for the cause or development of TASS. These include patient factors, substances introduced during the procedure, and unsterile medical instruments. As with many surgical post-op complications, patient factors should always be considered. Some patients who develop TASS have poorly controlled type 2 diabetes, hypertension, hyperlipidemia, chronic ischemic cardiovascular disease, or kidney failure. These diagnoses can increase the risk of TASS after an otherwise successful cataract surgery.
Eye surgery involves the use of intraocular viscoelastic materials, gel-like substances used to maintain the depth of the anterior chamber of the eye, manage bleeding and aid in the placement of the intraocular lens( IOL). Some of these materials are sodium hyaluronate( originally derived from rooster combs but now produced in labs); chondroitin sulfate( extracted from the cartilage of sharks, cows and pigs); and hydroxypropyl( extracted from wood pulp or cotton fibers). Each of these products can create side effects that may include inflammatory reactions, corneal edema( swelling) and a rise in intraocular pressure.
Studies have also indicated TASS reactions due to foreign bodies from surgery packs, povidone iodine and other ophthalmic ointments, contaminated balanced salt solutions, improperly manufactured IOLs, and extensive microscopic debris covering surgical drapes and other items. Another concern supported by numerous studies should also be considered: the role of cleaning and care and handling of surgical instruments.
Team-based approach to prevention
Those in the operating room( OR) or procedural areas are responsible for completing proper and thorough point-of-use treatment for instruments, including ophthalmic devices. Instruments should be wiped with a sterile, lint-free sponge or cloth using sterile water and following the manufacturer’ s instructions for use( IFU). Without this process and the moisture used to keep viscoelastic and organic material from drying onto the instrument, the risk of biofilm formation increases. Many experts and IFU recommend using non-enzymatic solutions with intraocular instruments. Be sure your OR team is using the correct sprays when performing point-of-use treatment.
Each day, SP teams process instruments from multiple specialties. Many facilities have one centralized location for the cleaning of these instruments. Both AAMI standards and AORN guidelines recommend having a separate location for the cleaning
of ophthalmic instruments. As most departments are limited in design, there is often not enough space or sinks to designate for only one specialty. If a department lacks a separate space, it is recommended to thoroughly clean the sink basins and ultrasonic before processing ophthalmic instruments. After manual cleaning, eye instruments should be run in the ultrasonic. An ultrasonic cycle is capable of breaking free debris that may be impossible to see or remove during the ultrasonic cleaning process. The ultrasonic should be used after manual cleaning, never in place of or as an alternative to it. After cleaning reusable intraocular instruments, lighted magnification should be used to inspect the devices for damage and retained debris.
As with any specialty, the facility must maintain an adequate inventory level of instruments to allow the time necessary to manage the cleaning process effectively. A lack of instrument trays can cause technicians to feel rushed and not able to thoroughly clean the instruments. Any device that is not cleaned properly cannot be sterilized properly.
It is also essential that facilities consider numerous factors before purchasing new ophthalmic. A representative from the sterile processing department( SPD) should be included in the pre-purchasing process and be ready to assess how effectively the SP team will be able to be in the cleaning of exceptionally fine lumens. Many of the cannulas used for injecting and irrigating during ophthalmic procedures are introduced into the surgical incision and may touch and be contaminated by tissue and debris being irrigated out. These small-lumened instruments require extensive flushing with copious amounts of critical water to ensure removal of all debris.
Due to the challenges of processing eye instruments, some facilities have switched to disposable devices or components. When introducing any disposable device, extra care must be taken to remove and properly dispose of it in the procedural area( and not allow it to stay in the tray). All SP team members must be trained to identify the single-use devices used in the facility so they will not reprocess them. It is believed that single-use devices may reduce the risk of TASS.
Prioritize training
Educating staff about what happens to a patient who develops TASS is critical in any discussion or training. While there are several variables associated with TASS, it is everyone’ s responsibility to know what it is and how to prevent it.
During SP training, it will be helpful to discuss what happens if an item is not cleaned properly, and how it will affect those in the OR and other procedural areas, as well as the patient. Everyone involved in ophthalmic procedures, including the SP team, must take every step to reduce the risk of TASS. The most critical thing SP professionals can do is increase their awareness of TASS and help provide workable, patient-centered solutions.
Tony Thurmond, CRCST, CIS, CHL, FCS, is the central service manager for Dayton Children’ s Hospital.
Resources:
Association for the Advancement of Medical Instrumentation, ANSI / AAMI ST79:2017 /( R) 2022 Comprehensive guide to steam sterilization and sterility assurance in health care facilities.
Association of periOperative Registered Nurses, Guidelines for Perioperative Practice, 2024.
jul-aug 2025 • www. healthcarehygienemagazine. com •
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