Confused about good infection prevention practices in ophthalmology? You're not alone. In our travels, we hear the same questions over and over. Here are the most common.

Multiple-dose eye drops

• Is it OK to reuse multi-dose ophthalmics? Not if a patient comes into contact with the dropper. Staff administering drops must follow appropriate hand-hygiene protocols (washing and gloving) and make sure there is no patient contact with the dropper. Immediately discard any dropper or product that comes in contact with a patient.
• When should I discard multi-dose ophthalmics? After 28 days. In lieu of any official guidelines on the best way to approach multiple-use containers of ophthalmic drops, the 28-day rule is a good option for outpatient eye centers. With some ophthalmics priced at $30 or more per unit, using them only once and then discarding is financially untenable for most facilities. The 28-day rule basically says that multi-dose containers can be reused but should be discarded within 28 days of opening, unless the expiration date comes first. After you instill the first drop of ophthalmic solution from a multi-dose container, the person administering the drop should label the container with the current date and the 28-day expiration (for example, "EXP: 01/15/11").

Prepping the eye

• Do I have to let the prep dry? Yes. Ophthalmic povidone-iodine should be the standard prepping agent for the eye, and like everything else, be sure to follow the manufacturer's instructions for the product you use. The efficacy of povidone-iodine is dependent on dry time, so let the prep dry on the skin as recommended. Avoid errors related to the mixing and diluting of different strengths of povidone-iodine in multi-dose bottles by purchasing single-use preparations. Hold annual competencies for the nurses and physicians who prepare the eye for surgery to review current protocols and promote standardization of procedures.
• Is iodine the only prep I'll need? No, work with your medical staff to find an alternative prep for patients who are allergic to iodine.

Decontaminating eye instruments

• May I use supplies from the drugstore to clean instruments? No. The surest way to incorrectly decontaminate instruments is to use equipment not specifically engineered for decontaminating surgical supplies. Examples include small ultrasonic washers used for jewelry instead of ultrasonic washers designed for medical decontamination, distilled water purchased from a local pharmacy rather than a medical supplier, and toothbrushes or pipe cleaners instead of brushes specifically made for eye instruments. Purchase these items from legitimate medical suppliers and follow all manufacturers' instructions when using them.
• Must I train my sterile processing techs? Yes. Provide annual and at-hire education for sterile processing staff. Device manufacturers may help you provide education on the finer points of washing and decontaminating ophthalmic instruments.

Short-cycle sterilization

• Is it OK to flash in open containers? No. Don't use open containers for short-cycle sterilization. In the fall of 2009, CMS clarified its stance on short-cycle or "flash" sterilization of surgical instruments in a memo to state surveyors, stating that routine flashing is acceptable at ambulatory surgery centers as long as loads are wrapped or contained and facilities follow manufacturers' guidelines for all devices involved. If you're routinely short-cycle sterilizing, use closed containers designed specifically for short-cycle sterilization and have them delivered to the sterile field covered. The scrub nurse should never leave the field to retrieve instrumentation from an autoclave. Eliminating the open pan reduces the risk of contamination while the instruments are being transported.

Invite your sterilizer manufacturer to provide an annual in-service for staff. The vendor can outline the correct settings for short-cycle sterilization to ensure your processing staff follows the guidelines correctly.

Make sterile processing improvements part of your capital investment plan. Even if your facility is small and your budget is tight, it's a good idea to make a capital investment plan to purchase additional instrumentation and/or closed short-cycle sterilization containers. Make the investment part of a quality improvement project that seeks to standardize the sterilization process at your facility.