Lessons learned from a failed implementation: Effective communication with patients in transmission-based precautions.

BACKGROUND: Patient engagement with transmission-based precautions can be an important strategy to prevent adverse events related to isolation. Most patient education is still highly prescriptive and is thus unlikely to help. Effective communication requires behavior change, leading to a meaningful dialog between the parties involved. OBJECTIVE: evaluate implementation process of a protocol for effective communication with patients in transmission-based precautions (Com-Efe). METHODS: Implementation research using qualitative methods in 4 sequential phases: (1) nonparticipant observation in inpatient wards; (2) design of the intervention for implementation; (3) adaptation of the Com-Efe through workshops with nurses; (4) final assessment of the implementation results through interviews with nurses. Study was performed in a public, secondary, teaching hospital. Consolidated Framework for Implementation Research was used as the reference for interview design and data analysis, aiming to identify barriers and enablers of the implementation process. RESULTS: Main factors that could have facilitated adherence were beliefs and perceived advantages in using the Com-Efe by nurses. Main barriers that may have contributed to the failure were the unfavorable climate for implementation, insufficient individual and leadership commitment, and the lack of understanding of the concepts underpinning effective communication. CONCLUSIONS: Despite using a systematic approach, the Com-Efe protocol was not fully implemented. The lessons learned in this study allowed us to propose suggestions for future protocol implementations in similar contexts.

Cytotoxicity of cannulas for ophthalmic surgery after cleaning and sterilization: evaluation of the use of enzymatic detergent to remove residual ophthalmic viscosurgical device material.

PURPOSE: To evaluate the cytotoxicity of reusable cannulas for ophthalmic surgery after the cannulas were filled with an ophthalmic viscosurgical device (OVD) and cleaned with an enzymatic detergent. SETTING: Microbiological Testing Laboratory, Department of Medical-Surgical Nursing, University of São Paulo School of Nursing, and Cell Culture Section, Adolfo Lutz Institute, São Paulo, Brazil. DESIGN: Experimental study. METHODS: The sample consisted of 30 reusable 25-gauge injection cannulas, 20.0 mm in length, whose lumens were filled with an OVD solution for 50 minutes. The following steps were used to process the cannulas: (1) presoaking, (2) washing the lumen using a high-pressure water jet, (3) backwashing with enzymatic detergent in ultrasonic cleaner, (4) preliminary rinsing with tap water, (5) final rinsing with sterile distilled water, (6) drying with compressed filtered air, (7) wrapping in surgical-grade paper, and (8) steam sterilization at 134°C for 4 minutes. The cannulas were then tested for cytotoxicity according to the United States Pharmacopeia 32. RESULTS: The cleaning protocol used in this study removed residues of OVD solution and enzymatic detergent as shown by the lack of cytotoxicity of all sample extracts. CONCLUSION: This cleaning protocol has the potential to minimize the occurrence of toxic anterior segment syndrome associated with residues of OVD solutions and enzymatic detergents. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Cytotoxicity of cannulas for ophthalmic surgery after cleaning and sterilization: evaluation of the use of enzymatic detergent to remove residual ophthalmic viscosugical device material

PURPOSE: To evaluate the cytotoxicity of reusable cannulas for ophthalmic surgery after the cannulas were filled with an ophthalmic viscosurgical device (OVD) and cleaned with an enzymatic detergent. SETTING: Microbiological Testing Laboratory, Department of Medical-Surgical Nursing, University of S~ao Paulo School of Nursing, and Cell Culture Section, Adolfo Lutz Institute, S~ao Paulo, Brazil. DESIGN: Experimental study. METHODS: The sample consisted of 30 reusable 25-gauge injection cannulas, 20.0 mm in length, whose lumens were filled with an OVD solution for 50 minutes. The following steps were used to process the cannulas: (1) presoaking, (2) washing the lumen using a high-pressure water jet, (3) backwashing with enzymatic detergent in ultrasonic cleaner, (4) preliminary rinsing with tap water, (5) final rinsing with sterile distilled water, (6) drying with compressed filtered air, (7) wrapping in surgical-grade paper, and (8) steam sterilization at 134C for 4 minutes. The cannulas were then tested for cytotoxicity according to the United States Pharmacopeia 32. RESULTS: The cleaning protocol used in this study removed residues of OVD solution and enzymatic detergent as shown by the lack of cytotoxicity of all sample extracts. CONCLUSION: This cleaning protocol has the potential to minimize the occurrence of toxic anterior segment syndrome associated with residues of OVD solutions and enzymatic detergents. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.