Eye Instrumentation and (TASS), Toxic Anterior Segment Syndrome
When I first heard of TASS, Toxic Anterior Segment Syndrome, I was at a educational seminar and it made me go back to my department and revaluate my processes of my ophthalmic instrumentation. TASS is serious damage to the intraocular tissue and vision loss as a result of contaminants introduced to eye during ophthalmic surgery.
There is a list of causes, but what stood out in regards to our profession was “Most cases of TASS appear to result from inadequate instrument cleaning and sterilization”, Toxic Anterior Segment Syndrome Journal of Cataract and Refractive Surgery 2006; 32:324-333. This statement reminds us on how important are roll is and the saying “If it is not clean; it is not sterile.”
Some causes of TASS are: detergent residues, foreign matter, and residues from sterilization processing. Detergent residue, struck an all too familiar perpetual issue, which I see from facility to facility, the correct dilution rate with detergent products. I have seen so often technicians simply pour the detergent and not take in account the measurement recommended by the manufacturer. The excess detergent could adhere to instrumentation and even with copious amounts of water will not rinse off. Then of course, it can permanently adhere on the instrumentation during sterilization. Following manufacturer recommendation for your detergents is a must and making sure it is constantly being followed.
Another area of concern is ultrasonic equipment not maintained or properly disinfected. You can just image what can grow on the walls and lid of an ultrasonic. “Heat stable endotoxin from overgrowth of gram-negative bacilli in water baths or ultrasonic cleaners”, Recommended practices for cleaning and sterilizing intraocular surgical instruments, J Cataract Refract Surg, Vol 33, June 2007. Ultrasonics in general need to be disinfected every time it is going to be refilled and as needed during its use. Eye instrumentation must have a “Designated cleaning area and dedicated equipment”, Toxic Anterior Segment Syndrome - TASS AAMI ST79-A1:2008 - Annex N. AAMI ST79 is a great source for obtaining information about properly processing eye instruments.
Sterilization residues are a concern. “Degradation of brass containing surgical instruments from plasma gas sterilization” and “Impurities of autoclave steam”, can contribute to TASS.
What does AORN have to say on the issue? We’ll “Special precautions should be taken for reprocessing ophthalmic surgical instruments” and “Provides a thorough list of recommended practices aimed at preventing TASS”, Ref: AORN Perioperative Standards and Recommended Practices (2009) Recommended Practices for Cleaning and Care of Surgical Instruments and Powered Equipment, Recommendation XIV
I am so glad I attend that particular seminar and heard about TASS when I did. This just reinstates that we need to continuously seek out educational opportunities to receive new and updated information in our practice in order for us to continuously implement best practice.
Cheron Rojo, CCSA Educational Director, CRCST, CIS