Ensuring Safe Sterilization of Ophthalmic Instruments in Clinics

Q: Ensuring Safe Sterilization of Ophthalmic Instruments in Clinics

Hello, Zihui： 1. It should have been disinfected. 2. It won't be that many. 3. It depends on the situation. 4. The probability should be low.

Instrument disinfection

The tweezers placed on the table next to the slit lamp in the ophthalmology clinic are sometimes used by doctors to remove foreign bodies from the eye or to express oil.
I have inquired with the ophthalmologists at the clinic, and they mentioned that alcohol disinfection is sufficient.
However, I am concerned that if a patient has a subconjunctival hemorrhage or a wound in their eye, the tweezers may not only come into contact with ocular secretions but also with blood.
Is alcohol disinfection of the tweezers adequate? I worry that using only alcohol for disinfection may still pose a risk of transmitting hepatitis B and C (similar to the hepatitis outbreaks caused by reusing needles that were only disinfected with alcohol).
Alcohol also cannot disinfect human papillomavirus; if the previous patient had flat warts on their eyelids, there is a risk of transmission to another patient.
Additionally, if the previous patient had conjunctivitis caused by Gram-positive bacteria, some doctors have mentioned that alcohol cannot effectively kill this type of bacteria.
I am concerned that incomplete alcohol disinfection could lead to bacterial conjunctivitis or styes.
1.
In large hospitals, are the tweezers placed on the table next to the slit lamp subjected to high-pressure, high-temperature sterilization for each use?
2.
Does the ophthalmology department in large hospitals prepare dozens or even hundreds of stainless steel tweezers to ensure that each one can be sterilized using high-pressure methods?
3.
If the issue is merely the removal of foreign bodies from the eye, does each patient in the outpatient ophthalmology clinic (not in the operating room) have access to a dedicated, high-pressure sterilized tweezer, or are they only wiped with alcohol?
4.
Is it possible for the tweezers placed on the table to become contaminated with airborne viruses from the table, leading to indirect infection when they come into contact with the eyes? (e.g., SARS-CoV-2)

Zi Wei, 40~49 year old female. Ask Date: 2020/11/11

Dr. Gao Pilin reply Ophthalmology

Hello, Zihui: 1.
It should have been disinfected.
2.
It won't be that many.
3.
It depends on the situation.
4.
The probability should be low.

Reply Date: 2020/11/11

More Info

Ensuring the safe sterilization of ophthalmic instruments in clinics is a critical concern, especially in light of the potential for cross-contamination and the transmission of infectious diseases. Your concerns regarding the use of alcohol for disinfecting instruments such as forceps used in eye examinations are valid and warrant a thorough discussion.

1. Sterilization Protocols in Hospitals: In a well-equipped hospital, instruments such as forceps should ideally undergo high-pressure steam sterilization (autoclaving) before use. This process effectively eliminates all forms of microbial life, including bacteria, viruses, and spores. It is standard practice in most hospitals to ensure that all surgical and examination instruments are sterilized between uses. However, the actual practice can vary between clinics and hospitals, and it is essential to confirm that the facility adheres to these protocols.

2. Availability of Sterilized Instruments: Larger hospitals typically maintain a sufficient inventory of stainless steel instruments that are sterilized and ready for use. This ensures that there are enough instruments available for each patient without the risk of cross-contamination. In outpatient settings, especially in ophthalmology, it is common to have dedicated instruments that are sterilized after each use to prevent any potential transmission of pathogens.

3. Use of Dedicated Instruments: In outpatient clinics, it is advisable that each patient has access to instruments that have been properly sterilized. While some clinics may use alcohol wipes for disinfection, this method is not sufficient for ensuring complete sterilization, especially in cases where there is a risk of exposure to blood or other bodily fluids. Ideally, each patient should have access to instruments that have been autoclaved, particularly for procedures involving potential exposure to infectious materials.

4. Risk of Surface Contamination: Instruments placed on surfaces can indeed become contaminated with pathogens, including viruses that may be present in respiratory droplets. This is particularly relevant in the context of airborne diseases such as COVID-19. While the risk of transmission through contaminated instruments is lower than direct contact with infected bodily fluids, it is still a concern. Therefore, maintaining a clean and sterile environment, along with proper hand hygiene and the use of personal protective equipment (PPE), is essential in minimizing the risk of infection.

In conclusion, while alcohol can serve as a disinfectant for cleaning surfaces and non-critical items, it is not adequate for sterilizing instruments that come into contact with mucous membranes or open wounds. The best practice is to ensure that all ophthalmic instruments are sterilized using appropriate methods, such as autoclaving, and to use dedicated instruments for each patient whenever possible. If you have concerns about the sterilization practices at your clinic, it is advisable to discuss them directly with the healthcare providers or seek care at a facility that adheres to stringent sterilization protocols. This will help ensure your safety and reduce the risk of infection during ophthalmic procedures.

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