Cataract Surgery: Lessons from the Operating Room

By Hassan Bilal, CRCST, CST | June 19, 2018

In healthcare, surgeries can take you in all directions. For the 9,000 ophthalmic surgeons in the United States, their hands are busy performing 3.6 million cataract surgeries.¹ The numbers are expected to go up too. The U.S. Census predicts the number of baby boomers will jump 27 percent by 2050, healthcare providers can plan for even more age-related cataract surgeries. Yet, there’s little hard data on just how serious the infections related to this surgery really are, but all OR teams can take away few lessons from what transpired in ORs where cataracts surgery took place.

Tasked with Tackling TASS

According to the CDC, toxic anterior segment syndrome (TASS) hit 8 of 10 patients at a 25-bed community hospital in Maine about ten years ago. Since then there have been numerous cases of clusters of the post-operative infection that causes inflammation or edema. Reporting and tracking must improve. The Food and Drug Administration argues that TASS is significantly underreported and surveillance is underway, but we realized the severity when the American Academy of Ophthalmology discovered more than half of its meeting attendees admitted to dealing with TASS in their facility.

Operating Room’s Role

To put an end to an outbreak, nurses and techs need to check expiration dates and lot numbers on medication given:

  • pre-operatively
  • intra-operatively
  • post-operatively

Central Sterile Tech’s Role

Techs must also identify surgical instrumentation used and the method of cleaning and sterilization. I also have to remind technicians and supervisors that they should NOT be using enzymatic cleaners during manual and/or mechanical cleaning. These detergents are a culprit for TASS.

My recommendation is to use a low suds detergent. Clean and ultrasonic the ophthalmic instruments separately from other instruments and rinse with copious amounts of distilled or sterile water especially on the final rinse of a manual and mechanical cleaning.

Some organizations and OSHA recommend a germicidal which is approved by the manufacturer for your medical devices and instrumentation if a thermal wash is not used for patient and worker safety.

Support Central Sterile

All of these recommendations are important, but we need to ensure the technicians get this vital information and also follow the Instructions for Use (IFU) which is the manufacturer’s validation testing for the FDA 510K. I cannot say this enough. Central sterile should be considered one of the most important and vital departments of a hospital or surgery center. Yet, it’s often the most underappreciated and underpaid, seen as a cost center for administrators. The average salary actually decreased in 2017 for this essential position.²

We need to make sure we’re investing in technicians’ ongoing training, that they receive imperative communications other departments are getting and giving them the resources they need for the safety of all patients especially when it comes to an infection that often exists in clusters like TASS.

Our experts can help guide you through our vast portfolio of products and solutions tailored for the central sterile department to help your hospital or surgery center make the right choices for the best clinical outcomes.


1. Lindstrom R. Thoughts on cataract surgery. Review of Ophthalmology. 9 March 2015
2. CS/SPD wants R-E-S-P-E-C-T. Healthcare Purchasing News. Kara Nadeau. March 2017.


Categories: Expert Views, Infection Prevention, Perioperative

Hassan Bilal, CRCST, CST

Operating Room Educational Consultant

Hassan Bilal supports and advises a sales force of over 1,000 Medline sales representatives on central sterile products, standards and technology which cover the United States and Canada. He is a voting member on the ST79 Sterilization Standards Committee for the Association for the Advancement of Medical Instrumentation (AAMI). He has instructed classes for Certified Surgical Technologist. He has also taught certification classes for students of the Central Sterile Association of Canada throughout Ontario. He speaks nationally at local, regional and state IAHCSMM chapters. He has also spoken at numerous Central Sterile departments, AHRMM conferences and AORN chapters.

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