April 2009 Insert Return to Homepage

Associates in Ophthalmology: Practice Background

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At Associates in Ophthalmology in Pittsburgh, an ophthalmic multisubspecialty ambulatory surgery center,we perform retina surgery, anterior segment surgery (cataract, refractive, and glaucoma), and more recently, occuloplastic surgery. In our center,we have three retina surgeons plus one retina fellow, four anterior- segment surgeons, and one occuloplastic surgeon. In 2008,we performed over 4,000 eye surgeries. Seventyeight percent of our retina cases in 2008 were performed with 23-gauge technology, 14% were 25 gauge, and 8% were performed with 20-gauge technology. 23- or 25-gauge cases account for approximately 92% of our vitrectomy case load.

As our surgical numbers can attest,we are a busy surgery center. The large volume of anterior segment surgery done in our center,makes it crucial that our retina surgeons operate at peak efficiency. Our operating rooms are in constant demand and we have four retina surgeons operating in them. This usually means that each retina surgeon has only one day per week to do their cases (of course we always allow time for add on cases as needed).The advantages of disposable instruments is a key to operating at peak efficiency. Using disposables allows our busiest surgeons to perform 8-10 cases in our normal OR day, drastically decreasing our turnover time when compared with reusable instrumentation. In the course of a typical turnover of reusable instruments, three to four different personnel come into contact with the retina instruments. This occurs as the instruments are taken from the surgeon, passed from the scrub tech, removed from the operating room at the end of the case, cleaned and sterilized, and then returned to the operating room to be opened by the surgical tech and then once again placed in the surgeon’s hands. At every step of this “loop” there is a very real chance that the fine tips of these 23- and 25-gauge instruments can be damaged or bumped. Even a small jolt to these delicate instruments can cause a tip to be blunted or a scissor to become misaligned. That leads to problems with sending out instruments for repair. It is my job to make sure the surgeon can trust the quality of the instruments placed in his hand.The only way to ensure this on a case-by-case basis is to use reproducible high-quality disposable instrumentation.

Another area of concern for OR Directors is infection control; in any situation where reusable instruments are used, there could be a risk of infection due to improper cleaning and sterilization techniques. The disposable instruments are sterile and individually packaged, therefore decreasing the chance of cross-contamination and sterilization issues that may occur with reusable instrumentation. The disposable instrumentation ensures that quality care is given to the patient every time.

Overall, I feel that disposable instrumentation has made an impact on our surgery center by ensuring safe, sterile instrumentation for every case, increasing our OR efficiency, and eliminating the concern for misaligned or damaged tips from processing.

Victoria Caumo, RN,BSN,CRNO, is the ASC Director of Nursing at Associates in Ophthalmology/Associates Surgery Centers in Pittsburgh.

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