Surgery

The technician’s role for in-office procedures

Assist physicians and patients by knowing the proper protocols.

BY JANET HUNTER, COMT

The doctor requests an in-office procedure. As an ophthalmic technician, are you confident that you know how to prepare and assist with the procedures?

Whether the doctor is performing a laser procedure or injection, you should be well versed in the following protocols:

• Confirming that the informed consent is signed by patient

• Preparing the patient prior to procedure

• Preparing the procedure table

• Assisting the physician

• Implementing best practices for office antisepsis, equipment and instrument maintenance

• Educating patients and reviewing post-procedure instructions

Here, I’ll explain how these protocols fit with common in-office procedures.

Intraocular injections

First, place the patient in the supine position with the headrest supporting the neck. Then, clean the lids and lashes of the operative eye with povidone iodine solution 10%, taking care not to get it into the eyes. Insert topical tetracaine or proparacaine eye drops into the eye several times, followed by a sterile lid speculum. If requested by the physician, a pledget soaked with lidocaine or tetracaine can be placed against the globe at the injection site. Next, place a few drops of povidone iodine 0.5% on the ocular surface and allow it to sit on the eye for at least one minute while ensuring that it covers the entire ocular surface.

Although each physician has different preferences, have the following items ready if needed:

• 4x4 gauze pads

• Cotton-tip applicators

• Eye wash

• Gloves

• Topical antibiotic drops

Post-procedure, rinse thoroughly with eyewash to remove all povidone iodine 0.5% from the eye. Instill one drop of the physician-requested antibiotic, and instruct the patient on post-injection drops and care.

Laser procedures

Prior to escorting the patient to the laser room, confirm that the laser is operational by powering up using the manufacturer’s guidelines. Place several drops of dilating and topical anesthetic drops into the patient’s operative eye as directed by the physician. Depending of the type of procedure (laser iridotomy, argon laser trabeculoplasty or selective laser trabeculoplasty), instill other drops into the eye, such as pilocarpine or brimonidine tartrate.

Once dilated, bring the patient to the laser room and seat them comfortably. Then, give instructions of what to expect during the procedure. Next, confirm that all lenses needed for the procedure are placed on the laser table. Place hydroxypropyl methylcellulose (Goniosol, Novartis Ophthalmics, Inc.) on lenses that come in contact with the patient’s eye. Also, wear safety goggles during the procedure to protect your eyes from the laser light.

Following the procedure, rinse the eye thoroughly to remove the Goniosol. Instill an antibiotic drop into the eye as directed by the physician, then provide patient instructions on post-operative care and drops.

Clean the laser lens by placing a few drops of mild soap on a cotton ball, gently wiping the lens surface, then rinsing under cool water. Allow the lens to dry by placing on a non-lint tissue. Disinfect the lenses by soaking in glutaraldehyde 2% aqueous solution for at least 20 minutes or bleach (1:9 ratio bleach to water) for 10 minutes. Rinse lens with cool water to remove disinfecting solution, then allow the lens to air dry on a non-lint tissue.

Instrument maintenance and sterilization

Patient safety is one of the main goals in executing in-office procedures. To that end, steps must be performed to guarantee that all surgical instruments are processed to the highest degree of microbial kill, also known as sterilization. The purpose is to prevent micro-organisms or pathogens from being introduced to the wound site.

Any instrument that comes in contact with the eye should be sterile. After use, if not able to immediately clean, keep the instruments moist to prevent any surface debris from drying. Submerge the instruments in a neutral pH cleaning and soaking solution (consult the manufacturer’s guidelines for instrument care before doing so).

Transport the soiled instrument to the decontamination area, which is the designated space in the office where reusable instruments and equipment are cleaned, disinfected, or sterilized. Then, rinse the items thoroughly with sterile water to remove surface debris. Manually clean the instrument using a soft bristle brush, or, if recommended by the manufacturer, place into an ultrasonic cleaner. Also, clean the instruments in the open position, if applicable.

After the instrument has been thoroughly rinsed with deionized/distilled water, visually inspect to verify no visible debris is present and allow to air dry. Once dry, place the instruments in a suitable packaging for steam sterilization. Protect sharp-tipped instruments with tip protectors, placed in the open position if applicable, and place a sterilization monitor in the package to verify exposure to the sterilization agent. Once the sterilization cycle is completed, remove the instrument packages from the unit and allow to completely air dry.

Surface disinfection

Infection control is very important to a medical practice. All employees should be educated in techniques for prevention of the transmission of infectious agents, and the correct protocol for maintenance of medical office cleanliness. (See “Surface disinfection protocols,” above.)

Disinfection reduces the amount of microbes but does eliminate all of them. Furniture in the room and tabletop surfaces are other sources for infectious agent and microbe transfer, so clean these surfaces before and after each patient with a sanitizing agent, such as diluted household bleach and water (1:10 ratio). The process of cleaning decreases the risk of transmission of pathogens to the patients and staff. OP

Janet Hunter, COMT, is the president and CEO of Eye Source, LLC, which specializes in ophthalmology technician training and clinical flow analysis. She has over 20 years clinical experience, managing, and teaching within the ophthalmology field. Also, she is an approved speaker with Alcon, Topcon Medical Systems, and JCAHPO.