# The utility of borescope and ATP Biofluorescence for inspection of ophthalmic phaco handpiece lumen: a single-center observational study

## TL;DR

This study shows that borescopes can detect hidden debris and damage in ophthalmic phaco handpieces, improving cleaning and patient safety.

## Contribution

The study highlights the underused utility of borescopes for visual inspection of phaco handpiece lumens.

## Key findings

- Borescope inspections found 56.10% of handpieces had foreign materials or structural damage.
- ATP testing showed all handpieces were clean, but missed visible issues like corrosion and rust.
- Green lint detection led to changes in sterile wipe usage to improve safety.

## Abstract

The presence of residual debris in the phaco handpiece lumen is implicated in the onset of intraocular inflammation. While ATP bioluminescence testing is accepted for evaluating the cleanliness of surgical instruments, the borescope’s ability to facilitate a visual inspection of the internal integrity of phaco handpiece lumens remains underreported. This study aims to evaluate the efficacy of current cleaning protocols and explore the borescope’s utility in visually inspecting phaco handpieces. In this analysis, 41 phaco handpieces underwent borescope examination and ATP bioluminescence testing following thorough cleaning, with two inspections completed on each handpiece. Borescope inspections revealed that 56.10% of phaco handpieces harbored foreign materials or exhibited various forms of structural damage, such as corrosion, rust, green lint, and discoloration. However, ATP bioluminescence testing deemed the cleanliness of all handpieces satisfactory. This study demonstrates the value of a borescope in the visual inspection of phaco handpieces, revealing issues such as corrosion and rust that necessitated immediate flushing of the lumen with sterile distilled or deionized water. The detection of green lint led to the prohibition of placing textile fiber-containing sterile textile wipes on the operating table surface by sterile supply staff, enhancing patient safety measures. Future efforts will focus on addressing the challenges posed by corrosion and particulate formation during rinsing.