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.

Fatores de risco relacionados à aquisição de bactérias multirresistentes em unidade de internaçao pediátrica / Risk factors associated with the acquisition of multiresistant bacteria in a pediatric nursery

Objetivo: Identificar os fatores de risco nos pacientes nos quais foram identificados bactérias multirresistentes, internados em enfermaria e UTI peidátricas de um hospital de ensino terciário. Métodos: Revisão dos prontuários dos pacientes internados de janeiro de 1995 a junho de 1997 nos quais havia sido diagnosticada a presença de bactérias multirresistentes em infecção ou colonização. Realizado um estudo caso-controle pareado usando-se o teste de McNemar para comparação dos grupos e análise multivariada por regressão logística. Foram pesquisados os seguintes fatores de risco: internação anterior, diagnóstico de doença crônica, internação em UTI, procedimento cirúrgico, uso de sonda vesical de demora, uso de cateter venoso central, uso de respirador, uso de antibióticos e presença de solução de continuidade da pele. Resultados: Foram identificadas 66 bactérias multirresistentes (33 gram-negativas e 33 S. aureus resistentes à oxacilina) em 52 pacientes. Pela análise de regressão logística do estudo caso-controle foram significativos apenas o uso prévio de antibióticos e a presença de solução de continuidade da pele. Separadamente, para os pacientes com bactérias gram-negativas multirresistentes foi significativo apenas o resultado de solução de continuidade da pele. Conclusão: O uso de antibiótico e a presença de solução de continuidade da pele foram os fatores relalionados à aquisição de bactérias multirresistentes; além da solução de continuidade da pele, para os pacientes colonizados com S. aureus resistentes à oxacilina, a presença de cateter venoso central também foi um fator de risco. As estratégias empregadas para limitar a disserminação dessas bactérias no hospiital devem considerar esses três fatores