Filthy surgical instruments: a threat in America's operating rooms (2014)

A few observations from the article from a surgeon’s perspective . First of all, I agree with the article that sterilizing modern equipment is more difficult. Back when you just had steel equipment, you could just throw them in an autoclave and be sure that they were sterile (with the exception of prion diseases). As the article mentions, a lot of equipment can’t take that kind of treatment and or has areas that are had to access such as long channels.<p>In additions, not all surgeries are created equal with respect to infection risk. Joint surgeries are some of the highest risk for infection. In fact, when doing open joint surgery, orthopedic surgeons will wear what looks like a space suit with helmet and air supply and work under a giant air suction device to keep the would from being contaminated. Add to that, that they were putting in foreign materials in the form of screws, and you have a recipe for disaster if there is the tiniest bit of contamination. As I have told my patients and medical students, a surgical infection is a life altering event. There is a good chance that you will never be the same after experiencing it.<p>I think this type of thing will be a bigger issue as we move forward. Surgical equipment is getting more intricate and more expensive. Everybody is pushing to cut costs. Having less equipment for a hospital is less capital costs, but more times that it needs to be properly cleaned, and every time you clean is an opportunity to screw up.<p>I think the ultimate answer might be taking the responsibility of sterilizing complex surgical equipment from the hospital to the manufacturer. Basically, the hospital would use the equipment once and send it back for reprocessing back to the manufacturer. For a lot of these surgeries, the manufacturer representatives are there at the hospital for surgeries requiring single use stuff likes screws, rods, artificial joints, etc so this would just add to the stuff they are bringing to the hospital anyway. It would be much easier for the FDA is o monitor and regulate a few reprocessing centers instead of every hospital. Simple equipment that you can just throw in an autoclave, can still be done by the hospital. Doing this would also force the manufacturers to think more about ease of cleaning since they would be the ones responsible directly for it.<p>Just my 2 cents.

It&#x27;s unsettling to learn that a life-saving surgery can compromised by a tech who didn&#x27;t spend a few extra minutes cleaning the tools properly.<p>I had read that surgeons were moving into using disposable instruments because of the possibility of prion contamination (prions can&#x27;t be destroyed by an autoclave). But maybe that was only for neurosurgery?

I think it was a book called &quot;The Hot Zone&quot; that talked about ebola and similar diseases. It also said the village elders in rural Africa stopped the spread, not the well-educated, monied foreigners from more developed countries.<p>They barricaded the roads and only let locals come in.<p>They told their people &quot;Don&#x27;t go to the white man&#x27;s hospital.&quot; because you would go to the hospital for a fixable problem, like a broken leg, and die of ebola contracted at the hospital.<p>They quarantined the sick. You couldn&#x27;t leave your hut. They would leave food on your doorstep to provide care. If three days food accumulated, they burned the hut down without verifying if you were dead or alive.<p>Antibiotic resistant infections and the like are partly a product of our modern mentality that tech can fix anything. Often, it can&#x27;t. Old fashioned procedures still have their uses and we don&#x27;t rely upon them enough.

Note that the article is from 2012, with some level of update in 2014.<p>It would be interesting to see whether these findings led to any improvements, although there&#x27;s a good chance that many of the same individual pieces of equipment are still in use. In also curious whether some of the changes in Medicare reimbursement rates for return visits made any difference since they were targeted specifically at unplanned returns and complications (Modifier 78, <a href="https:&#x2F;&#x2F;www.emblemhealth.com&#x2F;Providers&#x2F;Claims-Corner&#x2F;Coding&#x2F;Global-Surgery-Reimbursement-Policy-Concerning-an-Unplanned-Return-to-the-Operating-Room" rel="nofollow">https:&#x2F;&#x2F;www.emblemhealth.com&#x2F;Providers&#x2F;Claims-Corner&#x2F;Coding&#x2F;...</a>).

I imagine that routine use of antibiotics after surgery is covering up for a lot of this and is also contributing to antibiotic resistant bacteria showing up in hospitals with greater and greater frequency.

This is an important article.<p>I read several years ago about manufacturers sterilizing medical tools with radiation before they left the factory. I could imagine that the setup for doing that is too complex and dangerous for a regular hospital to run, but could it be offered as an outside service? Tools that can&#x27;t undergo autoclaving could be sent out for irradiation after every surgery.<p>But this is very much <i>not</i> my area, so there are probably a hundred things wrong with my suggestion that I&#x27;m too uneducated to see.

On the question of sterilizing prion-contaminated surgical instruments:<p><a href="https:&#x2F;&#x2F;consteril.com&#x2F;prion-sterilization-guide&#x2F;" rel="nofollow">https:&#x2F;&#x2F;consteril.com&#x2F;prion-sterilization-guide&#x2F;</a>

Trust but verify. Without independent verification, this is exactly the type of result that is expected.<p>If the manufacturers are not out in the field inspecting the devices and how they operate, how will they improve their designs in beneficial ways?<p>If the government regulators are not doing spot inspections of the equipment, how do they know they haven&#x27;t made a mistake in approving something, or that a hospital has not trained people properly, or whatever?<p>If you&#x27;re a patient, faced with these failures on the part of the regulators, the hospitals, and the manufacturers, what do you do? The whole system has failed here.

I&#x27;m surprised the patient went weeks without getting treatment for an obviously serious infection. When a friend had her knee replaced she received detailed instructions on recognising infections, including taking her own temperature twice a day, so it could be treated before it had any time to develop.

Candida auris is so persistent autoclaving, hydrogen peroxide and bleach aren&#x27;t effective... hospitals have had to resort to binning equipment and removing wall tiles. Imagine the hospitals &#x2F; ORs that are are less fastidious, and in the US, hospitals aren&#x27;t required to release statistics on preventable infections and deaths.

There is software that handles that issue. I wrote some in 2002 that uses bar codes and tracking to see what instruments need cleaning. We invented a lot of the tech involved with it into a Windows 98 Javalin touch screen. I migrated the database from Excel to Access and SQL Server to speed things up. Other companies had similar products but not GUI at the time.

Considering the amount of antibiotics used, doctors could probably use tools fished out a dumpster.

Makes sense that hospitals would do this in the United States. It&#x27;s a cost problem. Simply put, hospitals do not have the financial resources to fully clean their tools.<p>Last year I was in the hospital for 1 day and it cost me $10,000. What a travesty. How can doctors ever properly wash surgical tools with that paltry amount of money? Doctors and hospitals deserve better.

When you want to race automobiles but you aren&#x27;t an F1 driver there are leagues that will accommodate you. But not everyone is equally rich. How do you ensure that it&#x27;s driving skill that determines the winner, rather than who is willing to spend more money on a better car? You make a rule that says there are no rules about how much a car can cost, but that anyone can buy the winner&#x27;s car at the end of a race for $X.<p>I can&#x27;t help but think that a similar law might not be helpful. Make doctors and hospital administrators randomly subjected to these devices in a mostly-not-invasive procedure where sterile water is flown over the devices and then onto a finger-prick.<p>In both cases making people have true skin-in-the-game is the solution to the problem.