CIS SelfStudy Lesson Plan - IAHCSMM
CIS Self-Study Lesson PlanLesson No. CIS 251 (Instrument Continuing Education - ICE)Sponsored by:by Patti Koncur, CRCSTIAHCSMM Education SpecialistandScott Davis, CMRP, CRCST, CHMMCMaterials ManagerUniversity Medical Center of Southern Nevada,Las Vegas, Nev.OphthalmicInstrumentationLearning Objectives1. Explain the cleaning process forophthalmic instruments2. Describe basic ophthalmic instrumentsand the processes for their inspectionand assembly3. Discuss the sterilization process for eyeinstrumentationInstrument Continuing Education (ICE) lessonsprovide members with ongoing education inthe complex and ever-changing area of surgicalinstrument care and handling. These lessons aredesigned for CIS technicians, but can be of valueto any CRCST technician who works with surgicalinstrumentation.Earn Continuing Education Credits:Online: Visit www.iahcsmm.org for onlinegrading at a nominal fee.By mail: For written grading of individual lessons,send completed 15-question quiz and 15to: PEC Business Office, Purdue University, Stewart Center Room 110, 128 Memorial Mall, WestLafayette, IN 47907-2034.Scoring: Each 15 question quiz graded online atwww.iahcsmm.org or through Purdue University,with a passing score of 70% or higher, is worthtwo points (2 contact hours) toward your CISre-certification (6 points) or CRCST re-certification(12 points).More information: IAHCSMM provides onlinegrading service for any of the Lesson Planvarieties. Purdue University provides gradingservices solely for CRCST and CIS lessons. Directany questions about online grading to IAHCSMMat 312.440.0078. Questions about writtengrading are answered by Purdue University at800.830.0269.www.iahcsmm.orgEyes translate light into vision. Many people take theirsense of vision for granted until it becomes diminished or jeopardized. Safetyand mobility are impacted when our ability to see is compromised, and thetotal loss of vision can be devastating. This lesson plan addresses ophthalmicsurgical instruments and highlights the importance of proper handling, cleaning andinspection of opthalmic instruments to keep the devices well-functioning and preventeye injury in surgical patients.Objective 1. Explain thecleaning process forophthalmic instrumentsEye instruments are very small anddelicate with very fine distal tips that caneasily be damaged from routine handling.It is always important to carefullyfollow the most current manufacturer’sInstructions for Use (IFU) when handlingthese instruments to help preventdamage. The human eye is also verysensitive and reacts to foreign materialthat can remain in improperly cleanedinstruments. Note: Toxic Anterior SegmentSyndrome (TASS) is an inflammatoryresponse to this foreign material that cancause severe complications after surgery.Gross debris on ophthalmicinstruments should be removed, andinstrument lumens should be flushedwith sterile distilled water or anothersuitable agent, as recommended by themanufacturer during and immediatelyafter the surgical procedure. Theinstruments should also be carefullyplaced into their transport container,taking care to protect them from damageduring transport. It is important to keepeye instruments moist during transport,so any remaining soil will not dry on them.When possible, eye instrumentsshould always be processed separatelyfrom other surgical instrumentsto reduce the potential for crosscontamination from material or otherresidue on the other instruments. Onlycleaning agents recommended by theinstrument manufacturer should be usedduring the cleaning process. Cleaningsolutions should be diluted followingmanufacturer’s IFU. When presoaking,avoid stacking eye instruments on top ofeach other, which can cause damage.Carefully clean all tips, crevices, boxlocks, and serrations using materialsspecifically designed for use onophthalmic/microscopic instruments. Alllumens should be brushed and irrigatedto remove any debris. Instruments mustbe thoroughly rinsed following themanufacturer’s IFU. Cleaning solutions,rinse water, and disposable cleaning toolsand syringes used for eye instrumentsshould be discarded, as recommended bythe manufacturer.Reusable cleaning tools should beSEPTEMBER / OCTOBER 2015Communiqué
CIS Self-Study Lesson PlanPhoto 1: Vannas ScissorsPhoto 2: Arruga Capsule ForcepsPhoto 3: Serrefine Bulldogcleaned and decontaminated after eachuse, according to the manufacturer’s IFU.Many eye instruments cannot withstandmechanical cleaning, and if instrumentsare only manually cleaned, they should becarefully inspected with a magnifier forcleanliness after rinsing.Ultrasonic cleaning is effective inremoving soil from hard-to-reach areas;however, eye instruments should only beprocessed in an ultrasonic cleaner if thatprocess is approved by the instrument’smanufacturer.The ultrasonic cleaner should be filledand cleaning chemicals should be mixedas close to the time of use as possible.Allowing the solution to sit unused insidean ultrasonic cleaner for long periodsof time may result in the creation ofendotoxins, which can be a cause of TASS.Instruments should be placed in anultrasonic cleaner in a manner thatkeeps them from becoming damagedfrom the cavitation process; they shouldnot be stacked on top of each other.Note: cavitation is the process used by anultrasonic cleaner in which low-pressurebubbles in a cleaning solution burstinward to dislodge soil from instruments.Following ultrasonic cleaning, theinstruments should be carefully rinsedand inspected for cleanliness. ANSI/AAMI ST79, Annex N, states that thesolution should be changed at leastdaily, but, preferably, after each use.When changing the cleaning solution,the ultrasonic cleaner should be rinsed,cleaned and dried before adding moresolution.Delicate eye instruments should not beprocessed in a washer-decontaminator,unless recommended by theinstrument’s manufacturer. If a washerdecontaminator is used, always follow theinstrument manufacturer’s IFU regardingproper cycles.manner to protect them from damage.Common ophthalmic scissors includeCastroviejo, Vannas (see Photo 1),Westcott, and Enucleation.Forceps used in ophthalmic surgerymay be utilized in many other typesof procedures, especially those forplastic surgery. These forceps arefine-tipped and should be carefullyinspected to ensure they are clean andfunctional. They are very delicate andmost are not recommended for washerdecontaminator processing as theymay become damaged. Tips should beinspected to ensure they meet whenclosed and are burr-free. All serrationsshould be inspected for cleanliness, andthe proximal end should be checkedfor stress fractures. The delicate tips ofthe forceps should be protected whenpackaging. Common forceps include LensTying forceps, Jewelers, Bishop Harman,Lens insertion, Arruga Capsule (seePhoto 2), and Bipolar.Clamps hold small vessels and suture,and they are used to hold and turn theeyelid during surgery. Shapes and sizesvary depending on their intended use.Be sure the tips are in the open positionwhile the instrument is in the ultrasoniccleaner. Carefully inspect their fine tipsfor cleanliness and to ensure they meetevenly. Make sure all screws are intact andnot loose. Some clamps are very smalland should be packaged in a way that theydo not become lost in the tray. Commonclamps include Serrefine Bulldog (seephoto 3) and Chalazion (see photo 4),CommuniquéSEPTEMBER / OCTOBER 2015Objective 2: Describe basicophthalmic instrumentsand the processes for theirinspection and assemblyOphthalmic instrument inspectionsshould be done using some form ofmagnification to ensure the instrumentsare clean and damage-free. Many eyeinstruments look similar to those used inother specialties, so it is very importantto ensure the proper instruments areplaced into the sets. Each instrument typemay have different inspection points, sobecoming familiar with these instrumentsis a must for a CIS technician.Eye scissors, like all ophthalmicinstruments, are very delicate. Bladesmust be inspected carefully undermagnification for nicks, burrs andsharpness. Also, inspect box lock areasfor cleanliness, ensure the screw is inplace, and confirm there are no stressfractures. Most eye scissors should beprocessed in the ultrasonic cleaner, butthey are usually not recommended forwasher-decontaminator processing asthey may become damaged. Tips shouldbe protected to avoid damage, and theseinstruments should be packaged in awww.iahcsmm.org
CIS Self-Study Lesson PlanPhoto 4: ChalazionRetractors, also called speculum, holdthe eyelids open during surgery and/or hold tissue away from the operativesite. Designs vary from small delicatewire-type retractors to solid stainlesssteel hand-held instruments. Check themanufacturer’s IFU for specific cleaningand packaging requirements. Carefullyinspect tips to ensure they are intact,and ensure wire retractors are not bentor damaged. Carefully package wireretractors to protect them from damagefrom other less delicate instruments.Common retractors include Barraquerspeculum (see Photo 5) and Desmarreseyelid retractor (see Photo 6).Needle holders found in ophthalmicinstrument sets are also frequently foundin vascular sets. These needle holdersare usually spring action and five to sixinches in length. Care must be takenwhen handling these instruments becausethey are very delicate. Always check thetension of the spring action to ensure theneedle holder is in proper working order,and ensure the jaw insert is securelyin place. Processing needle holders ina washer-decontaminator may not berecommended, so it is important tocheck the manufacturer’s IFU for properprocessing instructions. Also, checkthe box locks for cleanliness, ensure thescrew is intact, and confirm there are nostress fractures. Protect the tips whenpackaging. The Castroviejo Needle holder(see Photo 7) is an example of this type ofinstrument.Lacrimal probes (see Photo 8) are usedwww.iahcsmm.orgPhoto 5: Barraquer SpeculumPhoto 6: Desmarres Eyelid RetractorPhoto 7: Castroviejo Needle HolderPhoto 8: Lacrimal Probeto dilate or probe the lacrimal ducts (tearglands) and are often made from silver tomake them easily bendable and pliable.Most lacrimal probes are five inches inlength, double-ended, and are availablein sizes from 0000 through 8. Manyprobes have olive-shaped ends. Manualcleaning is necessary and, if an ultrasoniccleaner is used, it is best to separate theseprobes from stainless steel instruments toprevent damage or corrosion. Inspect theprobes for cleanliness, ensure their shaftsare straight and intact, and examinethem under magnification to ensurethere are no cracks in the shafts. Checkto ensure all sizes requested are presentin the set. When packaging, protect theseinstruments from bending or becomingcaught in the tray mesh.Calipers (see example in Photo 9)are used for the precise measurementof the structures of the eye includingcornea and pupils. When closed, theyresemble a closed V-shape with very finedistal tips and a horizontal measuringbar at the distal tips. The center of thecaliper has a screw-type device to holdthe distal tips open or closed, and thebox lock area has a large holding screw.When closed, the distal tips should evenlymeet and be nick- and burr-free. Cleancalipers following the manufacturer’s IFUusing extreme care. Inspect them witha magnification device. Note: inspectionpoints include ensuring that the distal tipsare clean and intact. Check the box lockscrew to ensure it is intact and clean. Alsocheck the locking screw area for cleanlinessand function and protect the tips whenpackaging.Phacoemulsifier hand pieces (see Photo10) create ultrasonic vibrations, and areused to emulsify and remove cataractsduring cataract surgeries. They resemblesmall powered surgical saws with powercords attached. Strict adherence to themanufacturer’s IFU for cleaning, rinsingand sterilizing these devices is vitalfor successful surgical outcomes. Thelumens must be carefully brushed andirrigated. Failure to meet all processingrequirements can result in the patient’sSEPTEMBER / OCTOBER 2015Communiqué
CIS Self-Study Lesson Plan2. Association for the Advancement of MedicalInstrumentation. Comprehensive guide tosteam sterilization and sterility assurance inhealth care facilities. ANSI/AAMI ST79:2010& A1:2010 & A2:2011 & A3:2012 & A4: 2013.Photo 9: Castroviejo CaliperPhoto 10: Phacoemulsifer Hand Pieceloss of sight. The instruments are verydelicate and do not tolerate roughhandling or being dropped.In ConclusionProcessing ophthalmic surgicalinstruments is a challenge due to theirsmall and delicate composition. CIStechnicians must commit the necessarytime and effort required for thoroughand efficient processing to ensure positivepatient outcomes. The instrumentmanufacturer’s IFU must be carefullyand consistently followed to avoid patientincidences of TASS. Careful handlingand inspection will help preserve theseinstruments for many years.Objective 3: Discuss thesterilization process for eyeinstrumentationEye instruments should be sterilizedusing the methods and conditionsrecommended in the specific instrumentmanufacturer’s written IFU. Anydiscrepancies between the sterilizermanufacturer’s written IFU, the facility’ssterilization processing equipment, andthe instrument manufacturer’s writtenIFU should be resolved by contactingthe instrument’s manufacturer. Thesterilization process should be effective,monitored and documented.Immediate-Use Steam Sterilization(IUSS), formerly known as flashsterilization, should not be used as asubstitute for an adequate quantityof instruments. IUSS may create anadditional risk of infection to patientsbecause of time pressures placed onpersonnel to rush the cleaning andsterilization processes which, in turn,could lead to skipping necessary steps. IfIUSS is necessary due to an emergencysituation, the instruments must still besubjected to the same decontaminationprocess as those that receive terminalsterilization. Also, the instrumentmanufacturer’s recommended IUSScycles must be carefully followed whenperforming IUSS.CommuniquéSEPTEMBER / OCTOBER 20153. International Association of Healthcare CentralService Materiel Management. 2005.Instrumentation Resource Course:Identification, Handling and Processing ofSurgical Instruments.IAHCSMM acknowledges the assistance of thefollowing two CS professionals who reviewedthis lesson plan:Lisa Huber, BA, CRCST, ACE, FCS; SterileProcessing Manager, Anderson Hospital,Maryville, ILPaula VaNdiver, CRCST, CIS; OrthopedicSpecialist, Anderson Hospital, Maryville, ILResources1. Association of periOperative RegisteredNurses. 2013. Recommended Practicesfor Cleaning and Care of Surgical Instrumentsand Powered Equipment. PerioperativeStandards and Recommended Practices.CIS Self-StudyLesson PlansTechnical EditorCarla McDermott, RN, CRCSTClinical Nurse IIISouth Florida Baptist HospitalPlant City, FLSeries Writer/EditorJack D. Ninemeier, Ph.D.Michigan State UniversityEast Lansing, MIWANT TO BE AN AUTHOR?IAHCSMM is seeking volunteers to writeor contribute information for our CIS SelfStudy Lessons. Doing so is a great way tocontribute to your own professional development, to your Association, and to yourCentral Service department peers.IAHCSMM will provide guidelines andhelp you with the lesson to ensure it will bean enjoyable process. For more information,please contact Julie Williamson(julie@iahcsmm.org).www.iahcsmm.org
University Medical Center of Southern Nevada, Las Vegas, Nev. Lesson No. CIS 251 (Instrument Continuing Education - ICE) Learning ObjeCtives 1. Explain the cleaning process for ophthalmic instruments 2. Describe basic ophthalmic instruments and the processes for their inspection and assembly 3. Discuss the sterilization process for eye .
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CIS SELFSTUDY LESSON LAN Lesson No. CIS 279 (Instrument Continuing Education - ICE) BY SUSAN KLACIK, BS, CRCST, CIS, CHL, ACE, FCS, IAHCSMM CLINICAL EDUCATOR Environmental Responsibility: Keeping Sterile Processing Departments Clean and Functional Certified Instrument Specialist (CIS) lessons provide members with ongoing education in
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