Touching Eyes: Disinfecting Ophthalmology Devices

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By Brian Ward

A recent Quick Safety advisory from The Joint Commission (TJC) tells providers to do a better job sterilizing medical devices that touch patients’ eyes. This includes eye specula, YAG laser lenses, and tonometers. Improperly cleaned, these devices can spread infections such as herpes and HIV into a patient’s eye.

“We will continue to evaluate the processing of these devices as we always have,” said Robert Campbell, PharmD, director for medication management at TJC. “Organizations should be certain to understand the expectations for processing these devices.”

TJC issued the advisory because of patient safety concerns after it had to give out multiple immediate threat declarations because of improper disinfection of ophthalmology tools.

Anything that touches a mucous membrane is required to undergo high-level disinfection at minimum. Eyes fall into this category, and there are several infections that can be transmitted through eye contact:

  • HIV
  • Herpes simplex virus
  • Hepatitis C
  • Enterovirus 70
  • Staphylococcus aureus
  • Acanthamoeba
  • Adenoviruses
  • Pseudomonas aeruginosa
  • Methicillin-resistant Staphylococcus aureus
  • Prion diseases

In 2018, a study entitled “A Systematic Review Regarding Tonometry and the Transmission of Infectious Diseases” showed that direct contact between tonometer and eye contributes to the risk of cross-infection between patients.

“Prevention of all infectious diseases is desirable; however, it is especially crucial to prevent the transmission of HIV and hepatitis C virus,” the authors wrote. “Preventing the spread of these diseases is essential as immunizations are currently not available to assist in providing protection against transmission.”

Despite the infection dangers, TJC’s advisory says that healthcare workers are often unaware of disinfection requirements or misinterpret manufacturer instructions for cleaning. Many people use the wrong type of cleaners on ophthalmology devices.

Not following manufacturer guidelines can lead to more than just dirty devices. The wrong kind of disinfectant on a tonometer can cause the glue holding the tip together to dissolve, creating swelling and cracking that gives infectious particles a place to hide.

This isn’t the first time TJC has issued a warning about improperly cleaned medical devices. Nor is it our first time writing about ways to avoid infectious outbreaks with strong device reprocessing policies.

The Quick Safety alert lists several safety actions to prevent eye-transmitted infections, like:

  1. Reviewing reprocessing instructions for use of eye instruments to make sure they’re being cleaned properly.
  2. Performing high-level disinfection of items that touch intact surfaces of the eye, and sterilizing items that touch non-intact surfaces of the eye or are used for eye surgery.
  3. Ensuring that compatible disinfectants (other than bleach) are FDA-approved high-level disinfectants. Manufacturers sometimes list products that can be used for pre-cleaning, but that doesn’t mean they can be used as high-level disinfectants.
  4. Following manufacturer instructions for ophthalmology devices along with cleaning and disinfection products. Keep these instructions available for staff to use.
  5. Have someone knowledgeable on the subject review each disinfectant’s product label and instructions for use. If the instructions are unclear, call the manufacturer for clarification.