Joint Commission Recommendations for Disinfection of Tonometers and other Ophthalmology Devices

PUBLISHED: May 23, 2019
Relevant to: Ambulatory Care, Critical Access Hospitals, Hospitals, Long Term Care, Medical Office, Office-Based Surgery

The Joint Commission has issued Quick Safety #49, which addresses disinfection of tonometers and other ophthalmology devices. According to TJC, tonometers and other devices that touch the eye can be an infection risk to patients. TJC cites data from the American Academy of Ophthalmology that show inadequate disinfection of ophthalmology devices (including tonometers) can contribute to transmission of:

  • Adenovirus and herpes simplex virus HIV,
  • Hepatitis C virus (HCV),
  • Enterovirus 70,
  • Pseudomonas aeruginosa,
  • Methicillin-resistant Staphylococcus aureus,
  • Acanthamoeba,
  • Prions (transmissible spongiform encephalopathies, such as Creutzfeldt-Jakob disease)

TJC reports that data from their own surveys shows a lack of awareness and/or understanding of disinfection instructions for ophthalmology devices, specifically tonometers, YAG laser lens, eye specula. According to TJC, "...tonometer tips are particularly problematic becasue disinfectants can dissolve the glue that holds the hollow tip together, causing the tip to swell and crack."

In Quick Safety Issue #49, the following safety actions are offered:

  • Organizations should review cleaning and disinfection instructions for use of eye instruments to make sure the equipment is being reprocessed correctly.
    • Note: Any equipment that touches the intact eye surface requires high-level disinfection; any equipment that touches the non-intact surfaces of the eye or are used for eye surgery must be sterilized.
  • Organizations must ensure that the disinfectants they are using are compatible (other than bleach) and are U.S. Food and Drug Administration (FDA)-approved high-level disinfectants.
    • Note: Manufacturers often list products as compatible that may be used for pre-cleaning. Some of these products may be commonly available surface disinfectants but are not effective as high-level disinfectants.
  • Manufacturer instructions for equipment and the products used for disinfection should be readily available for all staff.
  • All disinfectant labels should be reviewed by the appropriate staff member to ensure understanding of instructions and if there is any uncertainty – the manufacturer should be consulted.

Included with today’s notice are example policies related to the reprocessing of ophthalmology devices.

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