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Are My Facility's Infection Control Practices Adequate to Prevent TASS and Infectious Endophthalmitis?
Whether your ophthalmic facility is preparing for an accreditation survey or just reviewing the implementation of infection control measures, it is important that your perioperative and reprocessing staff strictly adhere to your facility's disease prevention procedures. In recent years, the most common concern in ophthalmic surgery infection control practices is reducing the risk of toxic anterior segment syndrome (TASS) and infectious endopthalmitis. Having surgeons that are skilled at diagnosing between TASS and infectious endophthalmitis is critical because, both of these infections have very different treatment paths that are time sensitive and can result in vision loss if left untreated or misdiagnosed - which is more commonly the case.
What are the Differences Between TASS and Infectious Endophthalmitis?
Toxic anterior segment syndrome (TASS), an acute, noninfectious inflammation of the anterior segment of the eye, is a complication of anterior segment eye surgery; cataract extraction is the most common form of this type of surgery. Various contaminants, usually from surgical equipment or supplies, have been implicated as causes of TASS. The syndrome typically develops within 24 hours after surgery and is characterized by corneal edema and accumulation of white cells in the anterior chamber of the eye. Although most cases of TASS can be treated successfully with topical steroids, topical nonsteroidal anti-inflammatory agents, or both, the inflammatory response associated with TASS can cause serious damage to intraocular tissues, resulting in vision loss.
Endophthalmitis refers to bacterial or fungal infection within the eye, including involvement of the vitreous and/or aqueous humors. It is not caused by viruses or parasites; by convention, infection due to these organisms are included in the term "uveitis" (eg, cytomegalovirus [CMV] retinitis, toxoplasma chorioretinitis)....Most cases of endophthalmitis are exogenous, resulting from inoculation of organisms from the outside -- for example, from trauma, eye surgery, or as an extension of keratitis (corneal infection). Most cases of endophthalmitis are due to bacteria and present acutely. Acute bacterial endophthalmitis is a vision-threatening condition, onset between 3-7 days post surgery and must be managed as an emergency. ( http://www.uptodate.com/contents/bacterial-endophthalmitis )
The following AORN Home Study provides a clear breakdown of the differentiating factors between TASS and infectious endophthalmitis: AORN TASS Home Study Article
Steps You Can Take to Reduce the Risk of TASS and Infectious Endopthalmitis
- Eliminate intraocular use of medications or solutions containing preservatives (eg, benzalkonium chloride, sodium bisulfite, thimerosal, edetic acid).
- Periodically review cleaning and sterilization procedures with reprocessing staff
- Ensure perioperative staff know the chemical composition of all medications and solutions used during intraocular surgery
- Use disposable instruments and don't reuse single-use devices
- Review the following preventative guides:
AORN TASS Home Study
ASCRS/ASORN Recommended Practices for Cleaning and Sterilizing Intraocular Instruments
Avoid These 7 Mistakes in Processing Ophthalmic Instruments
Strategies for Reducing Flashing
Ambler Surgical is committed to supporting your infection control and patient safety practices so, please contact us if we can help in any way. We carry over 5,000 instruments and products to meet any of your center's needs. As always, most Ambler Surgical brand instruments are covered through our Free Lifetime Repair Program.
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