Twenty-eight percent of Canadian hospitals are reprocessing instruments designated for single-use. That's the result of a survey of over 400 Canadian hospitals in the May issue of Infection Control and Hospital Epidemiology. The hospitals are reusing everything from ventilator circuits to blades and drill bits to breast pumps, the survey showed. Worryingly, most are attempting to sterilize them themselves, although there are few guidelines on how to do so safely.
Dirty hands won't go unnoticed
It's the oldest, simplest and cheapest form of infection control. So it's baffling that only 40% of health professionals take care to regularly wash their hands while on duty.
Fed up, the body that regulates Canada's hospitals is cracking down on lax hygiene practices. By January, all hospitals and health institutions will have to prove they're auditing staff handwashing practices in order to stay accredited, announced Accreditation Canada boss Wendy Nicklin in late May. Although accreditation is voluntary, except in Quebec where it's mandatory, most hospitals in the country do seek the organization's stamp of approval.
Montreal Jewish General's Dr Mark Miller isn't worried about the stepped-up measures."Most hospitals already do spot audits," he says. "Everybody's jumping on the handwashing bandwagon, which is great. But it's not new."
His hospital is among those that monitor staff handwashing and he doesn't foresee any major policy changes. "But we may have to make it more high profile to satisfy the public's expectations," he admits. |
The study was led by Dr Michael Gardam, head of infection control at U of T's University Health Network and co-author of the Ontario Hospital Association's guidelines on single-use devices. He's been a leading figure in the battle against nosocomial infections in Canada's hospitals and helping clean up C difficile outbreaks in Sault Ste Marie and more recently in Burlington.
Recent HIV and hepatitis C infection scares linked to improper sterilization of surgical instruments at facilities in Nevada, Saskatchewan and Alberta have shone a spotlight on hospital sterilization processes. The current study didn't look at what specific adverse events could be linked to reuse of single-use devices.
STEADY TREND
Seven years ago Dr Mark Miller, Montreal's Jewish General's infection control head, led a similar survey. He's appalled that the new study found that not much has changed in Canada's hospitals since his study highlighted the problem.
So why do hospitals continue in this risky practice? "The number one reason is cost," he says. There's a lot of cynicism that the manufacturers are just labelling everything "single-use," because that way they don't have to prove they can be safely reprocessed. "There's a lot of validity to that," says Dr Miller. "For example, biopsy forceps, for sure they could be reprocessed. The problem is they come in a package that says they're single-use, and we can't make the assumption that they can be reused."
The problem is, without extremely detailed instructions on how to reprocess each instrument, there's no guarantee that it won't transmit infection the next time it's used. There are currently no facilities in Canada certified to reprocess single-use devices. Many hospitals ship devices to American reprocessing facilities, which can cost thousands of dollars.
PHYSICIAN ROLE
Dr Miller says surgeons not taking a leadership role in this is a big part of the problem. "Doctors close their eyes to this," he says. "When we asked doctors if they'd used reprocessed single-use instruments, many said they didn't know. It's kind of an ostrich approach."
It's in a doctor's own best interest to make sure the tools they use have been properly sterilized, he adds. "When a physician puts out his hand for a medical instrument he's responsible to ensure it's safe. Physicians need to ask where it came from, if it was properly sterilized. If it's not, they should refuse to use it."
Dr Miller also urges hospitals to switch to multi-use devices wherever possible and negotiate better prices for their single-use devices, like they did at the Jewish. "We saw a dramatic 75% cost reduction," he says. "Biopsy forceps went from $40-50 to around $10."
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