Optical illusions: The vital importance of instructions for use and intentionally approaching eye device processing.

BACKGROUND: The purpose of this process and quality improvement activity was to address opportunities identified with cleaning, disinfection, and sterilization requirements for eye devices, and implement a robust and sustainable processing system to support safe patient care. METHODS: Through the lean 6 Sigma methodology, the evaluation of noncritical, semicritical and critical device processing was conducted. A hierarchal approach to law, regulation, manufacturer's instructions for use, evidence-based guidelines, consensus documents, facility risk assessments, policy, and procedure was conducted. Over 15 diverse clinical areas within a large health care network were assessed for utilization of ophthalmic and optometric devices, with the review of inventory for manufacturer-instructed cleaning, disinfection and sterilization compliance. RESULTS: An interdepartmental multidisciplinary team with oversight of over 10 service lines led the implementation of point-of-use treatment, transport, high-level disinfection, sterilization, storage, and documentation based on intended use. CONCLUSIONS: During this experience, infection Preventionists performed a vital role in supporting a highly reliable cleaning, disinfection, and sterilization process. This undertaking required a team approach to apply instructions for uses and evidence-based practice that promoted sustainability and ultimately led to supporting the prevention of health care-associated infections and patient harm.

Appendicitis among liver transplant recipients.

Appendicitis among liver transplant recipients has not been described in the current literature. We report 8 recipients who experienced appendicitis three weeks to 181 months after liver transplantation (LT). Initial presenting findings differed from the nonimmunosuppressed population in that a majority of the patients did not have leukocytosis (>10,000 cells/mm3). Four patients experienced perforation, three of whom presented three days after the development of abdominal pain. All patients recovered after surgery without untoward sequela.