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Subscribe to RSSA new report suggests doctors across the country are using surgical tools contaminated with blood and other debris and because the FDA doesn't require hospitals to report it, many incidents are unknown. NBC's chief medical editor Dr. Nancy Snyderman reports.
Most people feel anxiety before a surgical procedure. They may have an even bigger reason to worry. A new report from the Center for Public Integrity suggests there may be unseen perils lurking in the surgery suite: the very instruments used in the operation may be contaminated with dangerous pathogens.
Although surgical tools are supposed to be cleaned and sterilized between operations, researchers have discovered that these devices can emerge from the cleaning process with bits of bone, blood and tissue from the previous operation, contaminants that can become reservoirs for some potentially lethal bacteria.
TODAY spoke with the author of the new report, Joe Eaton, an investigative reporter for the Center for Public Integrity, a Washington, D.C. nonprofit that focuses on ethics and public service.
Q: Do we know how widespread this problem is and how often patients actually come down with these scary infections?
A: That’s the crux of the issue. We really don’t know how many people end up with infections from surgical instruments. Studies that have looked specifically at dirty devices have shown that there is definitely a problem. A study at the University of Michigan, for example, looked at 350 suction cups that had been cleaned and sterilized. They found that every one of them contained blood, bone, tissue, even rust. If the devices are dirty it’s not only gross but potentially dangerous, since there’s a potential for passing on infection.
Q: What’s the problem with cleaning these tools? Can’t the heat just be turned up higher to kill all the bugs?
A: As surgery has moved more and more to high-tech devices it’s become a bigger problem. They’re not built just out of metal and glass anymore. Some of these polymers can melt if you heat them to high so they need to actually be cleaned. They’re sent to the hospital basement and cleaned in some cases by poorly paid and poorly trained technicians whose last job might have been Burger King. Some of these people are being paid as little as $8.50 per hour.
Q: If the devices are still dirty even after the hospital follows the manufacturer’s instructions, what’s the solution?
A: I think the solution is probably two-fold. First the manufacturers need to be required to design devices that can be cleaned in real world environments. Second, hospitals need to be forced to make sure the devices are clean before they’re used on patients. One thing that might help there is to require more training for the people doing the cleaning.
Q: What about the FDA? Aren’t they supposed to make sure these devices are designed properly and are being safely used?
A: There’s a real problem with follow-up. When there was an outbreak in Houston that was traced to dirty arthroscopic shavers, the FDA mandated a safety review of the shavers. But they asked the manufacturers to do their own testing. When the manufacturers came back with tests showing that the devices were not clean that was the end of it. There was no follow-up. So nothing happened.
Q: Is there anything patients can do to protect themselves?
A: The only thing you can do is go to the best hospital you can. But you need to realize that even there something could happen.
Q: What do you hope happens as a result of your story?
A: This is an issue just coming to the forefront within the community. I hope the story pushes it onto a larger stage and that people who set policy realize it’s a very serious issue. Even when it comes to surgeons, many do not know what happens to the instruments they use and where they’ve been before they wind up in the surgery suite.
Linda Carroll is a regular contributor to msnbc.com and TODAY.com. She is co-author of the new book "The Concussion Crisis: Anatomy of a Silent Epidemic.”
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I would like to see a follow up story about hospitals reprocessing medical devices by third party companies. This, in my opinion, is something the public deserves to know about not only because of the chance of cross-contamination but also because these reprocessed devices are purchased for a substantially lower cost, yet still charged to the patient for the price of a new device. The article stated that "100% of suction tools are contaminated", but my question is, why would one reuse ANY kind of suction tool on a different patient? Hospitals have a duty to follow specific standards of care and treat patients equally, however today it seems those standards are weighed too heavily on ways to increase profitability.
I had a hysterectomy in June of 2010 The hospital used a robotic machine called the Davinchi., I was released from the hospital the next day and was readmitted that night due to a staph/bacterial infection that had developed in one of me incisions. I couldnt stand up all the way, couldnt lay flat and it was hard to walk around. They had to reopen one of my closed incisions to clean the infection out. 3 days later they released me with a gaping hole in my tummy that i had to clean numerous times a day, it took over a month to heal and close back up. I now have a horrible scar and that incision is still painfull at times.
This story didnt surprise me one bit, It makes me wonder how many patients get a bacterial/staph infection after surgerys due to surgical equipment that isnt clean all the way.
Wow!!! I watched this story about dirty instruments being used in surgery, GROSS. They talked about certification of techs and low wages. Finally!
I said this over and over again when I worked in CSS (Central Sterile Supply). I was always criticized by my coworkers for taking too much time cleaning my instruments. I could never get them to understand that this is a crucial job that had better get done properly.
We were the lowest paid in the department and when I transferred out, there were 4 techs less than when I started and about 6 more OR rooms that were running 24-7 as opposed to the 7 a.m. to 5 p.m. shift that was the norm when I started there. They also took my full time job and split it into two part-time jobs with no benefits. I tried to explain to management that no one would care about the job they were doing if they weren't valued as an employee and paid at least more than someone flipping burgers. Their response was "there's only so much money in our budget". This from a hospital that made huge profits every year and gave the CEO huge raises, redecorating the hospital, again and AGAIN, while telling us they couldn't pay us a fair wage.
While there, I devised a system where everyone's instruments were identified by who cleaned them so we could find out who was not doing their job (which was most of them). Those employees were "talked" to. I witnessed employees take the stringer of instruments and simply run them under running water to clean them, when each instrument was supposed to be taken off the stringer and washed separately. Instruments were going through the washer and coming out to the OR table with blood still dripping from them!
It's time that attention was paid to this undervalued job. If you want the job done right, you have to stop telling the employees to hurry, and, stop overwhelming them with too much work, and pay them what they are worth!
I also complained repeatedly about disposable instruments being reused on surgical trays. I was told that they were approved to be re-sterilized up to 10 times. Not "used" and re-sterilized. No one ever kept track of this, however, even though I complained over and over again. It's way past time things were done properly. Demand it!
Thanks Scrapper for sharing your knowledge with us, much appreciated.
I agree with everything you said scrapper. It's disgusting to know that there are instruments used in the OR which is suppose to be s sterile atmosphere that have contaminents on them. This article surely opened my eyes as I will be thinking twice or thrice before I have any procedures done. I am a nurse and I know there are contaminents in the hospital that just can't be prevented no matter how much you try. I believe that when a surgical procedure is to be performed it should be done with disposable instruments. They charge for the use of instruments that are re-usable so what is the difference if they are disposable. I believe this would cut down on a lot of unnecessary infections. The health care system is all a money making institution that could care less about the patient. I am tired of doctors ripping off seniors and even those who are able to pay for their own gratification. I have a wonderful PCP whom I will be giving up because I will go on Medicare next year. He charges Medicare patients a $60 adminstrative fee because he doesn't get enough from them for the physical. He treats all patients 65 and over as though they all have the same symptoms. Its sad when doctors put themselves ahead of the care for their patients. I'm at a point I don't trust anyone in healthcare anymore. Thank you for your article on sterilization.
So true - sadly it is all about the almighty dollar and reimbursement. In order to "stay alive" financially, the OR must keep the rooms constantly busy - an empty OR means loss of income. So, it is booked as full as possible, turnovers are pushed as fast as possible, which means that instruments have to be available and ready as soon as possible. No instruments means no surgery. Combine that with poorly paid worker-bees, and this is the result. Then, the doctors &/or nurses see dirty instruments on their table, with a patient asleep and ready to open - needless to say all hell breaks loose, and you have to tear everything down and start all over again. It is indeed a problem.....fixed when you can hire quality, conscientious workers who are allowed time to thouroughly clean....and, now we are right back around to the financial bottom line again! Has anybody ever considered why the CEO's of insurance companies are millionaires??? THEY are the ones controlling the pursestrings, not the hospitals.
After 25 years in the business I can finely say thank you to someone for getting this story out, thank you NBC. Please do not stop, there is more to this story. Check out my website at, csspdmanager.com and learn more about what hospitals need to know.
I was required to have a quadruple heart bybass last year in February and in May my stalpes in my sternum was coming apart. On May 25th the heart surgery decided to operate again to re-wire my sternum and when they opened me up, they found three diffferent infections had attacked my sternum and therefore they were required to remove my sternum and part of my leaft rib cage. I am frustrated, because when a hospital or surgeon causes the infection from improper sterlization, there is nothing a patient can do legal to recover the additional pain and suffering one encounters. I definitely feel for your guest whom was interviewed on your show today. I agree with the nurse who stated that certification would be required. Thank you for getting the word out and hopefully the FDA will do something.
I read Steven Edwards coments. I feel sorry what happened to him. Are you sure there is nothing a patient can do legally to recover for the attitional pain and suffering? I had hip surgery in AUG. 2010. Two weeks later new hip replacement "poped out ". Put back in at the ER and sent back to care home to rehab. Ups ! hip "poped out again. Dr.wants to open up and remove replacement and put a new one in. Then back to care home and rehab. About a week later or sooner I had a major infection (MERSA) The Dease Controll Agency was called in and started heavy anti bio. Soon after I became allergic to then. Hip replacement removed and a spacer put in.Still infected; remove spacer and put another one in. Finally infection cleared up and finally last surgery and another hip replacement on March 31,2011 (8 MONTH LATER). what was to be a two week hospital & rehab was awfull. Today is 2/22/12 and I still can't walk with help and I can't lift my upper leg. Why don't we have a legal recorse?
I worked 22 years in hospital CS and I was certified for only four of thse. We used an ultrasonic washer, but we were still required to inspect the instruments for cleanliness and functionality. Disposable items were tossed after use because they were manufactured to be used once only. The problem here is that the MBAs who make the decisions don`t like to maintain a large inventory, so the turnaround time for processing is not as long as it should be. If a problem happens in a surgery and they need additional gear, that adds to the squeeze. The amount of waste that occurs in hospitals is huge. I can see where managers who know nothing about medical procedue or disease transmission would look at all the unused stuff in the trash and think "there must be some way we can use this." Unfortunately, there is not a way. Disposable means exactly that. The things aren`t made to be reused. They won`t do the job if you try it. I`d say we need to hold hospials and doctors financially responsible for infections and other mishaps that patients suffer. "Tort reform" is code for let them off the hook. Write laws to protect the patient, not the establishment. If nothing else it might discourage corporate medicine. We need medicine, not bean counting.
I have worked in the OR and SPD for over 35 years. As the manager of a Sterile Processing department I deal with the challanges of supplying our end users with instruments that are clean and working properly on a daily basis. Although we strive to make sure that every instrument is clean prior to assembly and sterilization it does not always happen. We are human and we make mistakes. We get pushed, we get screammed at and we are stressed to get the job done. Even through we have an accuracy rate of 99.6%, 1 soiled instrument in the OR is to much. We do require that all of our staff become certified and maintain the certification. If they do not they are no longer eligible to work in our department. There is no excuse for a department not following standards and guidelines set by AAMI, AORN, FDA and the Joint Commission. The leadeships of the SPD's need to take a stand and not cut corners, not take short cuts and not comprimise the patient. They need to have sufficient staff to pprocess instruments properly. They need to purchase enough instrumentation so they do not have to be quickly turned over and "flashed" between cases. It is costly to have a large inventory but it is far less expensive than dealing with a law suit or the negative publicity that an event like this would have to an organization. It has been said that SPD can be compared to the foundation of the hospital. We are in the basement because like the foundation we support the entire building. Without us the hospital would colapse. In my department patients come first, always have, always will.
As a Sterile Processing Technician I would like to say that I am amazed it has taken this long for this issue to reach the news. Most people have no idea that there is even a need for a Central Sterile Supply/ Sterile Processing Department in health-care institutions, let alone a Sterile Processing Technician to work there. The challenges that an SPD Tech. faces daily would make most run screaming from the workplace yet they persevere to do the best job possible, because they know that their job has a direct impact on the care of patients.
A SPD tech. knows that in order for an instrument to be sterilized, it must first be cleaned, and there is no such thing as "Sterile Soil", yet there are still no Regulations in this country defining clean, this lack of a definition was a hot topic at last years AAMI/FDA workshops on the Reprocessing of Medical Devices. Presently "Clean" means the lack of Visual Soil, but is that clean given the fact that there are places that cannot be visualized without a scope (like the arthroscopic shaver in this clip). In fact there are presently only two countries in the world that have defined what "clean" is and that definition is in micro-grams of residual protein.
A Sterile Processing Tech.know that in order to clean instruments properly they must follow the instrument manufacturers Instruction For Use, but many of these IFU's for cleaning are vague or overly technical or involve cleaning methods and or cycles that don't fit into the time constraints to get the instrument processed, and to add insult to injury here, when your cleaning instruments in the Decontamination room there are hundreds if not thousands of instruments that need to be processed in a day, lets see you remember all their different IFU's.
Now while I'm speaking of Manufacturers may I say that part of the problem of retained soil comes from poor design, that Yankuer suction tip, that you saw Bi-sected in this video clip with soil had a "dead end" that trapped blood and tissue that no brush, cleaning chemistry, or cleaner could reach. Once the protiens in this soil denature it would take a blow torch to remove them. This was the same issue that cuased retained soil in the Arthroscopic Shavers.
Although there are many organizations (AAMI, AORN,SAGE..etc.) that recommend that cleaning begin at "Point of Use" these are only "recommendations". I can not begin to tell you the amount of gross contaminate I have seen arrive with instruments, again the longer this organic soil is allowed to dry and denature on instruments the harder it will be to clean.
Sterile Processing Technicians are the "Unsung Hero's" of health care...most of them are "doing their best with what they have available to them". I am lucky enough to Live and work in the one State in the Country that requires Certification for Sterile Processing Techs. (Thank You New Jersey!)yet even here I would have to say that most SPD techs are not properly compensated for the work they do. It is worse in other States that do not require certification, most techs there could make more money flipping burgers at "Mc-E-D's". We know the constraints of our job, and many of us have voiced our reccomendations (sometimes on deaf ears) to processes that would make things better. The bottom line seems to be this...What is more Important, the health and well being of our patients or the profit margin of the institution?
I was not going to leave a comment but, I thought I should add. Number one I am a surgical tech, I've worked in the OR for more then twenty years, I have scrubbed in every specialty. The cost of disposable instruments would drive health care cost through the roof and trust me you won't want them used on you or your family members. The problem is not down in central supply. The instruments they are mainly talking about are instrumentation that has to be cold processed in between cases, like flexible scopes, endoscopic instruments, cameras, reamers and instrument with tubes like suctions. If you look at the instrument in the picture it's a endoscopic shaver. Most hospitals don't used reusable suction tips anymore. The instruments they are speaking about are very expensive and delicate. A flexible endoscope they use to do endoscopy for example costs about $40,000. To clean them you have to run lots and lots of water down them and clean them well before they are processed. The main problem is with high tech instrumentation that has to be sterilized by Eto gas (ethylene oxide) the process takes hours. If you have more than one case you have to process the instruments in the OR
When we are setting up instruments for cases we are supposed to check them. If any instruments are dirty the whole set up is contaminated. As a surgical tech I would not let any instrument touch a patient if it is dirty. I don't care how much the doctors yell, how backed up the cases are for the day. There are supposed to be safe guards, the buck stops in the OR. No matter what happens dirty instruments should not reach the patient and I am saying it rarely happens. Even if the FDA didn't track the infection, the department of health does. If a hospital or a Dr has a high infection rate it is investigated by the hospital, if the rates of infection are very high the department of health investigates. Hospitals are tracked, you can actually find the rate of infections and deaths of a hospital and Dr. Any good hospital would be more than happy to give you the information or to tell you what web site to go to for the numbers. Do your homework, check out your hospital before you need it. A great place to start is your city department of health. Every hospital has a risk management department. Trust me every hospital, knows if they have an high infection rate, the infection rates for the doctors. Implants are tracked. Hospitals are inspected by the department of health. In order for a hospital to get Medicare funding, run transplant programs, keep trauma center status they have to pass inspection.
Money is tight and competition between hospitals is intense. I guess what I'm saying is - 99% of instrumentation used for OR cases is fine it's sterile. Infections are tracked. 97.9% of infections in a hospital are from staff not washing their hands or breaks in aseptic technique during surgery Staph lives on the skin and in the nose of a lot of people you do not have problems until there is a break in the skin. Here are some tips. If you have surgery.
1. A week before do not shave the area, try as much as possible not to get any nicks or scrapes. You have to try to keep skin intact that includes no scratching if possible.
2. When you go to hospital don't let health care workers touch you unless they wash their hands with soap and water. - speak up for yourself
3.When having dressings changed - don't let anyone change your dressings until they wash their hands and put on gloves
4. If your dressings fall on the bed or anywhere else tell them no - get a fresh sterile one.
5. Your dressings should be placed on the wound not dragged across your skin.
6. Pay attention to the person as they change your dressings, make sure they open all your supplies at once and don't open one item touch your wound and open another item and touch your wound or dressings.
7. When you get home make sure if and when you change your dressings you wash your hands before and after. Keep your wound as clean and dry as possible.
8. Most of surgical infections are due to wound care after surgery. Oh I forgot one of the most important things - if your nurse or the person changing your dressings has fingernail polish, fake nails even long nails - ask them to wear gloves.
If you have an allergy to fake jewelry or to metal ask your doctor not to use skin staples. I found out the hard way I had a ten inch incision it looked great for about a week, my skin started to pull away from the staples, the holes where the staples enter the skin got bigger. My incision fell apart. I was lucky I didn't get an infection.
9.If you smoke you have to stop until your wound heals, smoking slows healing.
10. Speak up, ask questions you are a customer. Ask what the infection rates are for your type of surgery. Make sure you know how to take care of your wounds.
Here is a link about wound closure and wound care. Ethicon has a lot of information. I hope this information is of some help.
There is an real issue but nothing, that really loose sleep over. Just look into infection rates. Anytime you have a break in skin you are at risk of infection. People should be more concerned about the over use of antibiotics. Don't use them unless you really need them, believe it or not that also plays a big part in infections after surgery.
Sorry for the long post they took out the link pilonidalorg/_assets/pdf/wound_closure.pdf try this in google search or just google ethicon wound closure pdf. Ethicon has a lot of information