Infection and How It Affects the ASC

How will the TASS outbreak and other infections change regulation?

Mr. Sheppard: The eyecare industry has just gone through a rather extensive investigation of toxic anterior segment syndrome (TASS) and its implications for reusing instruments. What's your impression of the extent of reuse? What are the implications in terms of infection control?

Ms. Harmer: I was a member of the TASS task force, and it was an incredible group of individuals — multiple vendors in the industry, nurses, physicians and representatives from the FDA and the CDC. The result was an excellent document that was coauthored by the American Society of Cataract and Refractive Surgery (ASCRS) and the American Society of Ophthalmic Registered Nurses (ASORN). "Recommended Practices for Cleaning and Sterilizing of Intraocular Surgical Instruments" can be found online at asorn.org.

Mr. Sheppard: I'm sure the recommendations are detailed, but maybe you can share some highlevel take-aways for infection control.

Ms. Harmer: First, too many people have stopped using enzymatic detergents. Enzymatic detergents are not the problem — ineffective rinsing is the problem. The detergents do what they're made to do, but they're not made to remain on the instruments. Overall, people need to know they can't sterilize everything the same way. Proper care and handling requires the user to know each manufacturer's directions for use, which includes proper cleaning and sterilization. In the past, there was a lot of misinformation about sterilization requirements, and TASS was one of the results. The task force concluded that, far and away, care and handling practices contributed to TASS. ASC staff need the skills and expertise to provide safe patient care.

There's only one ASC license. Ophthalmology cases may not require some of the procedures necessary for more contaminated cases in other surgical specialties, but we're all caught in the same wide net. We'll all be involved in the same regulation. — Stephen C. Sheppard, C.P.A., C.O.E.

Mr. Sheffler: With all the publicity about methicillin-resistant Staphylococcus aureus (MRSA) and thousands of people dying from these untreatable bacteriological syndromes, some state health departments are focusing heavily on instrument processing. For example, in New Jersey, surgeons can use only wrapped instruments. No flash sterilization is allowed.

In New Jersey, we're facing very heavy-handed regulations. There are certifications for instrument washing and infection control, and courses are required in certain states. I think regulations may rise to a federal level if infections increase.

Mr. Sheppard: I agree. There's only one ASC license. Ophthalmology cases may not require some of the procedures necessary for more contaminated cases in other surgical specialties, but we're all caught in the same wide net. We'll all be involved in the same regulation. Speaking of requirements and regulations, next, let's take a look at accreditation. OM