"It's always been taken
for granted that the instruments should be sterile,"
says Dr James Ka-Ying Yao, a cardiovascular and thoracic
surgeon at St. Michael's Hospital in Toronto, "just
like the food we eat."
But just as food safety has been thrown into doubt lately
-- think avian flu and mad-cow disease -- so has the proper
sterilization of instruments and devices used in hospitals.
Lately it seems as if there's a new hospital sterilization
scandal every other week. Few provinces have emerged unscathed,
with a growing number of hospitals across the nation being
implicated in the litany of transgressions.
UNSTERILE
ENVIRONMENTS
Thanks to a shortage of instruments, inadequate training
of sterilization staff, failure of some manufacturers
to provide explicit cleaning instructions, and just
plain human error, the risk of infecting patients with
contaminated instruments is something that just cannot
be underestimated.
Between last fall and January of this year, nine Ontario
hospitals informed hundreds of patients that there was
a possibility that they'd been infected with hepatitis
or HIV by improperly sterilized equipment. In one case,
the disinfectant used in a sterilization machine had
run low so detergent was used instead. In another, it
was discovered that technicians were missing a step
in the sterilization process for an ultrasound used
for trans-rectal biopsies. Unclear instructions in the
machine's manual were blamed.
Around the same time, hospitals in Labrador advised
over 300 women to get HIV, hepatitis and STI tests after
it emerged that instruments used for gynecological exams
and procedures hadn't been properly sterilized. Patients
were none too impressed that it took the hospitals eight
months to get around to telling them about the lapse
and many are now suing. In March of this year, two Montreal
hospitals -- the General and Sacre Coeur -- recalled
close to 300 hip surgery patients after it was discovered
that the reamer handles used in the procedures had not
been disassembled for cleaning. And the list goes on.
The latest scare came in April, after the Queen Elizabeth
II Health Sciences Centre in Halifax launched an investigation
into the possible exposure of surgical patients to Creutzfeldt-Jakob
disease (CJD). Although improper sterilization procedures
were not at issue in Halifax -- CJD has a protein that's
resistant to sterilization -- the QEII case has, nevertheless,
brought the discussion about contaminated hospital equipment
to the table.
SITUATION
CRITICAL
Doctors can't assume that all the instruments handed
to them during surgery and other procedures and exams
are sterile, warns Adrienne Brown, president of the
Community and Hospital Infection Control Association
(CHICA) and manager of Infection Control Services for
the Joseph Brant Memorial Hospital in Burlington, ON.
"Doctors need to be looking more critically at
devices, paying more attention to visible wear and tear
on equipment," she says. "As they become more
aware, they'll start noticing things they might never
have noticed before. During a
hip replacement procedure, for example, when a doctor
notices cement on the instrument, he may be more likely
to question whether or not the cement is sterile because
it's been through an autoclave, or if it poses a potential
risk to the patient."
Elizabeth Henderson, PhD, an epidemiologist based at
the Peter Lougheed Centre in Calgary, says keeping patients
safe from contaminated instruments requires constant
vigilance -- and learning. As new instruments become
available to hospitals and clinics, infection control
personnel, as well as doctors, must make it their business
to know how they should be cleaned and sterilized. "For
surgeons, it would be helpful if they read up on the
sterilization procedures of each instrument, particularly
if they're dealing with new instruments," says
Dr Henderson. "Doctors should be asking questions
and working with staff to ensure instruments are optimized."
INDUSTRY/HOSPITAL
ROLE
But while doctors clearly have an important role to
play in ensuring the safety of instruments, other stakeholders
in the healthcare industry also need to step up their
efforts to protect patients from infected equipment.
According to Stephen Dibert, President and CEO of MEDEC,
the Toronto-based association that represents the medical
devices industry, instrument manufacturers and hospitals
have to work together to make sure that sterilization
attendants follow proper cleaning and sterilization
processes.
To drive this point home, MEDEC recently sent out a
reminder to its members about the importance of going
into hospitals and providing comprehensive training
on cleaning and sterilization. Mr Dibert says that the
provincial medical associations should follow suit by
helping physicians understand the importance of proper
sterilization of medical instruments.
Hospitals are also cleaning up their acts, reviewing
sterilization procedures, adopting more stringent standards
and increasing the focus on training of infection control
staff. "The Ontario Hospital Association has had
education days on reprocessing and that message is getting
out to other provinces as well," says CHICA's Ms
Brown.
Back at St Michael's Hospital, it's business as usual
for Dr Yao. Patients facing surgery don't seem particularly
anxious about contaminated instruments and as far as
he can tell his colleagues are confident that the infection
control processes in place are safe and effective. But
Dr Yao is adamant that confidence definitely doesn't
equal complacency. "There's no question,"
he says, "we're concerned about it."
|
