A recent study evaluated the microbiological safety of reusing surgical instruments and supplies—including surgical cannulas, syringes, phacoemulsification and coaxial/bimanual irrigation/aspiration tips, and phacoemulsification sleeves—for cataract surgery.
Conducted at Aravind Eye Hospital in India, the study aimed to determine whether reusable materials carried any contamination risk after being cleaned and sterilized using immediate-use steam sterilization, a process involving short cycles of high-temperature steam sterilization between surgeries.
The Aravind Eye Care System (AECS) performs thousands of cataract surgeries annually. Reusing surgical instruments presents an opportunity for sustainability in decreasing medical waste, and “has allowed AECS to provide approximately 60% of its surgeries for little to no monetary cost to its sizable indigent population,” the investigators described in their article, published in the Journal of Cataract and Refractive Surgery.
Cultures from 3,333 samples revealed no bacterial or fungal growth after immediate-use steam sterilization (IUSS). Further, none of the 3,241 cataract surgeries that used these instruments resulted in postoperative endophthalmitis (POE), and the POE rate did not increase in 2 million consecutive procedures. POE rates between the AECS population and reports from the American Academy of Ophthalmology IRIS registry were also similar.
In 2014 the U.S. Centers for Medicare and Medicaid Services declared that IUSS should not be used for routine sterilization, the researchers found short-cycle autoclaving of unwrapped instruments with FDA-approved sterilizers was sufficient for sequential, same-day ophthalmic cases. This study prompted the release of specialty-specific sterilization guidelines from various North American ophthalmology societies.
The researchers acknowledged that while the study did not encounter positive cultures, this is not a guarantee that there was no microbial contamination, and there is still a risk of contamination or endophthalmitis. However, they concluded, “these findings add to the growing body of evidence on the outcomes of reusing certain ophthalmic surgical products and supplies that are labeled as single use….The economic and environmental effect of unnecessary operating room waste with so common a procedure as cataract surgery demands further study of more sustainable practices that do not compromise patient safety.”
A full list of author disclosures can be found in the published research.