Dirty medical instruments are used during surgeries at hospitals and outpatient surgery centers "with alarming regularity," the Center for Public Integrity's iWatch News reports.
According to an iWatch News investigation, improperly cleaned surgical tools have led to various high-profile disease outbreaks in recent years. For example, the Department of Veterans Affairs in 2009 found that improperly cleaned endoscopes were used to perform endoscopies or colonoscopies on 10,737 veterans in Florida, Tennessee, and Georgia between 2002 and 2009. Some of those veterans later were diagnosed with HIV, hepatitis C, or hepatitis B.
Meanwhile, a hepatitis C outbreak in Las Vegas in 2008 was attributed to unclean surgical equipment at one outpatient surgery center. A subsequent CMS investigation of 1,500 outpatient surgery centers found that 28% of facilities had infection control deficiencies associated with equipment cleaning and sterilization.
Challenges to proper surgical equipment cleaning
According to iWatch News, several factors may impede proper cleaning of surgical equipment, including tool design and certain hospital sterilization processes.
For example, although intricate modern surgical tools have transformed medicine, iWatch News notes that they often are difficult to clean. Some tools feature internal channels that easily trap materials. In addition, some tools cannot be cleaned using steam sterilization, while others are made of materials—such as rubber—that cannot be fully heated.
"Cleaning was once a basic factory job," said Joe Lewelling, vice president of standards development at the Association for the Advancement of Medical Instrumentation. "Now it's very complex. It takes a lot of steps. It's more like a laboratory process."
At the same time, many hospitals continue to sterilize instruments in "central sterile processing" units, where staff are under pressure to quickly turn over medical equipment, iWatch News reports. In the country's largest hospitals, these units can process as many as 40,000 instruments per day.
Despite recent efforts by the International Association of Healthcare Central Service Materiel Management and various state-level organizations, iWatch News notes that only New Jersey requires equipment sterilization workers to receive certification (Eaton, iWatch News, 2/22).