Care for ophthalmic surgical instruments: Protocol

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SOP FOR CLEANSING AND CARING FOR OPHTHALMIC SURGICAL INSTRUMENTS
1) Wipe off blood: at the joints, tips and ridges.
Use gause and normal saline.
Ideal setting: heated normal saline in a galley port on the operation table
2) Put the surgical instruments in jik water:
Rationale: for disinfection.
Duration: 5 minutes; because too long stay in jik corrodes or rusts the instruments
3) Put the surgical instruments in soapy water:
Use distilled water.
NB: Tap water should not be used because it has calcium and magnesium ions which make it hard water,
rendering it unsuitable in cleaning surgical instruments as it will not lather well
A soft toothbrush can be used to clean each instrument as it is seemingly better than gause.
4) Rinse the surgical instruments with copious amounts of distilled water (preferably warm) to remove
the detergent/soap.
Recommended to disassemble the parts of hinged instruments so as to expose and cleanse all the parts.
5) Dry the surgical instruments:
Use a drier. Dry instruments thoroughly before storage or they will wet and rust.
Lay them out on a tray
6) Lubricate the hinged instruments: scissors, needle holders and artery forceps.
Rationale: Lubricants prevent development of stiff joints and inhibit the development of corrosion.
The instruments are dipped one by one into the lubricant.

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Avoid immersing cannulas into lubricant as some authors assert that it’s a risk factor for Toxic Anterior
Segment Syndrome (TASS)!
7) Packing:
Carefully pack the instruments in trays.
Have a silicone mat which protects the instruments from rusting.
Spray or add some oil to the silicone mat/tray.
During sterilization; whole tray is inserted into the sterilizer as a whole.
8) Shelving. Flexible modular racks are designed for temporary storage of surgical kits so they stay sterile. The usersimply
slides the basket or shelf containing the instrument kit into one of the storage columns, keeping each kit separate from the
others.In our setting we have a metallic cabinet with well arranged racks to facilitate organized shelving.
9) Security: lock and key system
10) Keep a log of the daily inventory:
Record: which instruments are used? How many are broken or lost? How many new instruments are
added? How many are faulty?
Relevant definitions:
Stain: a discolouration on an instrument’s surface
Rust: red or orange colouration on the surface of surgical instruments resulting from oxidation.
Pitting: erosion/corrosion of an instrument’s outer surface, renders it beyond repair. Tiny visible small
dots, large deep holes.
Alternative approaches to removing stains:
1) Non-invasive cleaner
2) Commercial stain powder
3) A pencil eraser may be sufficient to remove the stain
4) If more than 5% of the instrument is stained; thorough investigation or quality assurance study ought
to be done to determine the causative factor.
5) Use ‘cocacola’ to remove resistant stains.
6) Ideal stain remover is Nosozym, or Prolystica. Contains combination of enzymes (protease, lipase,
amylase) that degrade the proteins, fats and blood residues. It removes event the toughest deposits.
Drafted by: Dr. Bashir Ali Muhammed, and Dr. Iddi Ndyabawe
Residents in Ophthalmology Department; Makerere University College of Health Sciences. (MAKCHS)
Date of drafting: 22/12/2020
Sources:
-Lecture series by Dr. Otiti Juliet - Sengeri, Head of Ophthalmology Department; MAKCHS; held on 28th September 2020.
-Lecture by Dr. Lori Pacheco on ‘Decontamination and Sterilization of Ophthalmic Surgical Instruments’ hosted by Cybersight on 6th
October 2020.