Tuesday, October 23, 2012

The Dirty Secrets Behind Dirty Surgical Instruments

As I have written about a lot lately, patient exposure to unclean medical instruments appears to be on the rise.  Pittsburgh, Pennsylvania is no exception.  When a phenomenon like the increased prevalence of dirty surgical instruments begins to rise we have to explore explanations for the change.

Today Health, an online extension of the Today show (I think?) did just that in an article from February of this year titled "Today Investigates: Dirty surgical instruments a problem in the OR."  The investigators from from Today uncovered a couple of important issues that partly explain the explosion of dirty instruments.

First, it was noted that "the handling of the increasingly high-tech instruments can be a weak link in hospitals’ patient safety net."  This is exactly what happened in a recent class action lawsuit brought against Forbes Regional hospital.  In that case, it was determined that when new colonoscopes were purchased and placed in to surgical rotations, none of the staff bothered to read the instructions to see if there were any new steps for the cleaning process.  As a result, the new colonoscopes were not cleaned correctly and patients were needlessly exposed to dirty instruments.  Thus, while it is important for medical facilities to strive to incorporate the most current technology for the benefit of the patients, the process has to be handled correctly.

Second, Today reveals a dirty secret of the medical profession, while the operating rooms are manned by highly trained professionals,"The departments responsible for cleaning and reassembling surgical instruments -- usually known as “sterile processing” -- are frequently found in hospital basements and sometimes staffed by underpaid hourly laborers. These workers can be a forgotten and neglected part of the team involved in a surgical procedure. As the CPI report indicates, the sterilization workers say they feel more like they’re doing an unrecognized service, with pressure from nurses and surgical staff to make the process as fast as possible. The faster the instruments make it into the operating rooms, the more patients are moving through the surgical suites. But what may seem like a push for efficiency can backfire, with disastrous consequences."  Amazingly, New Jersey is the only state that requires hospital sterilization workers to undergo training."

While experts note that this is a job that must be done by skilled and certified technicians, more often than not the job falls to unskilled, lower-paid professionals.  Worse yet, while the FDA requires device manufacturers to provide cleaning instructions they don’t require hospitals to report dirty surgical instruments that find their way into operating rooms. And, only 25 states are required to report surgical site infections.

It seems to me that the Joint Commission on Hospital Accreditation, the groups that essentially sets the standard expected of hospitals, will eventually enact new standards that will raise the bar for medical instrument cleaning.  We can only hope.

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