Recently, there has been concern and confusion about the interpretation of standards and survey process regarding sterilization in ophthalmic facilities.  Over the past year, the American Academy of Ophthalmology (Academy) and the American Society of Cataract and Refractive Surgery (ASCRS), along with the Outpatient Ophthalmic Surgical Society, have discussed the concerns of ophthalmic surgery centers with the Joint Commission.  The new position statement, released by the Joint Commission on June 15, 2009, clarifies the interpretation of standards regarding steam sterilization.   

The Joint Commission announced a refocusing of its survey efforts on all of the critical processes involved in sterilization, not just the selection of the sterilization cycle or method.  If the process is considered complete and performed well, then the Joint Commission will consider it effective.  Thus, the use of a shorter steam sterilization process for unwrapped instruments will no longer be considered "ineffective," without considering all of the aspects of the sterilization process. Joint Commission surveyors will observe processes of cleaning, sterilization, and transportation of instruments, and ask for manufacturers' instructions. 

Ophthalmic surgery centers under the purview of the Joint Commission should be familiar with the Position Statement on Steam Sterilization as well as the Centers for Disease Control/Hospital Infection Control Practices Advisory Committee Guideline for Disinfection and Sterilization in Healthcare Facilities.

In addition, it is recommended that attention be paid to the following:

• Avoid using the antiquated term, "flash sterilization."
• Clean and rinse all surgical instruments appropriately after each case, as per the manufacturer's instructions.
• Follow the manufacturers' instructions for instrument sterilization, both the sterilizer and the instrument manufacturer.
• Protect instruments from recontamination during the transport to the sterile field.

Have a written policy in place for protocols for what happens (cleaning, handling, sterilization procedure) to the instruments prior to each surgical case and after each case in accordance to the manufacturers' instructions.

The American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery co-chair a Task Force on Ophthalmic Sterilization, with participation of the Outpatient Ophthalmic Surgery Society.  This task force has met with the Joint Commission to discuss its sterilization criteria for accreditation and provided information about the unique characteristics of ophthalmic surgeries and instrumentation and the rate of surgical site infections in ophthalmology.