Sustainable practice: is it safe to sterilise and reuse surgical instruments?

Clinicians have explored the safety of sterilising then reusing instruments during cataract surgery at Aravind Eye Hospital in India.

The research, which was published in the Journal of Cataract & Refractive Surgery, highlighted that the carbon footprint of a single phacoemulsification surgery performed at the Aravind Eye Hospital is 20 times smaller than the same operation performed in the UK.

The authors shared that this is largely due to standard operating room protocols that include the routine reuse of multiple surgical devices, as well as the reuse of surgical supplies.

The study involved taking samples from a range of instruments and devices that are reused during cataract surgery at the Aravind Eye Hospital.

For example, cannulas and syringes are processed with steam sterilisation between cases. A single bag of 500ml irrigation fluid is used on four to five cases, while phacoemulsification tubing and handpieces are reused over multiple cases before being sterilised at the end of the surgical day.

The researchers took 3333 discrete samples from different types of equipment used in 3241 cataract surgeries. In all collected samples, no bacterial or fungal growth was observed.

Among the patients who received surgery with the sampled equipment, there were no patients who developed endophthalmitis over a six-week follow up period.

“This microbiological data complements clinical endophthalmitis data from two million consecutive cases at the Aravind Eye Hospital, suggesting that their instrument and surgical supply processing practices may allow for safe and sustainable ophthalmic care,” the authors concluded.

The postoperative endophthalmitis rate at Aravind Eye Hospital is 0.04%.