Despite all we've learned in recent years about so-called "superbugs" and ever-growing discussion around prevention, hospital-acquired infection (HAI) outbreaks continue to make headlines.
The carbapenem-resistant enterobacteriaceae (CRE) outbreak at Ronald Reagan UCLA Medical Center linked to "dirty" scopes is just the most recent example and points to the critical need in hospitals to pay more attention to medical devices as a potential source of cross contamination. For providers, this means taking a closer look at the way we handle and clean these devices in order to protect patients.
Taking a step back, providers depend on and closely follow the cleaning guidance and disinfection instructions provided by medical device manufacturers. While this should be sufficient, the reality is that these recommendations may not be enough to keep patients and staff safe. In fact, there is a growing body of evidence that so-called "disinfected medical devices" are not as clean as we would all like to believe. At UCLA, every indication is that medical personnel followed cleaning guidelines recommended by the manufacturer to the letter, and yet the scopes remained contaminated with deadly bacteria.
So what can healthcare organizations do to reduce the risk of this kind of outbreak inside their walls?
Here are three things to consider:
Go the extra mile with instrument sterilization
In response to the superbug outbreak, the FDA noted that the complex design of some devices may prevent effective cleaning, even when manufacturer instructions are followed. The lesson? When it comes to device sterilization, the onus is on providers to do more than the basics.
Going the extra mile may include, whenever possible, taking devices apart before cleaning to ensure that every piece is cleaned effectively and even cleaning some components by hand prior to sending them for automated reprocessing.
In addition, organizations should demand that the manufacturers and distributors they work with provide the most extensive cleaning instructions possible customized for their organization. These instructions should take into account not just cleaning of the instrument itself, but also the environment in which equipment is cleaned. For example, large, high volume hospitals may not be able to clean every instrument on a daily basis so devices may end up sitting for days before reprocessing. Additionally, storage and cleaning areas are often located in the basement of medical facilities where it can be dusty and damp. All of these factors come into play when thinking about how to best clean a device and all need to be taken into consideration when developing hospital-specific protocols and processes.
Consider single-use products whenever possible
In response to the Ebola crisis, the CDC suggests released guidance for U.S. hospitals treating "known or suspected" Ebola victims. Among their recommendations, the CDC suggested that "dedicated medical equipment (preferably disposable, when possible) should be used for the provision of patient care." It's a recommendation that hospitals should seriously consider regardless of Ebola because the only way to truly prevent device-related transmission of disease is to ensure that devices are used on one patient and then disposed of.
While some devices, like the duodenoscopes used at UCLA, are not available in disposable form, there are countless real-world examples of HAI outbreaks that could have been prevented if existing disposable products had been used. Take Dallas-based Parkland Memorial Hospital—in 2010, it was forced to notify 73 female patients that they were potentially exposed to infectious agents (including HIV and hepatitis) due to both equipment failure and the reuse of an improperly sterilized vaginal speculum. Not only did the cross-contamination scare have the potential to harm to patients, as well as their partners, it also caused significant reputational damage to the hospital.
Many organizations have already made the move to reduce the potential risk of cross contamination by replacing reprocessed devices with disposable instruments such as speculums, anoscopes, retractors and laryngoscopes, just to name a few. Newer iterations of some of these devices even feature built-in light sources, eliminating the need for external lights that are, themselves, potential vehicles disease transmission while also increasing convenience for providers who no longer have to search for lights prior to an exam or procedure.
Continuously update sterilization policies and protocols
Controlling HAIs and cross contamination is no longer just a serious health issue, it's also a significant financial one now that healthcare reform legislation ties infection control to Medicare payments. In order to avoid these penalties, hospitals need to consistently revisit their policies and protocols to make sure that they are up to date and are posing no risk to their patients.
Again, these protocols should be tailored to fit each organization's specific and unique needs and should be adjusted as those needs (and potential threats) evolve. For example, as new disposable options hit the market, organizations should weigh the pros and cons of adopting those devices in place of the reusable products currently in use. Or if the design of a particular device makes cleaning and sterilization a challenge, providers need to adjust their protocols to reflect a more intricate cleaning requirements and even consider implementing specific quality control programs to govern those instruments.
While the recent "superbug" put a spotlight on the role of medical devices in infection control in an unprecedented way, these are considerations that every healthcare organization should keep top of mind at all times. This discussion should also serve as a positive reminder of how technological advances can help reduce the risk of cross contamination not only in acute situations, but also to address the daily need for greater diligence and enhanced infection control in healthcare settings of every size each.
People come to hospitals to get better—not sicker—so it falls on all of us to work together to protect patients, staff, and even the reputation of our institutions, from HAIs.
Douglas H. McConnell, M.D., F.A.C.S., is Medical Director at OBP Medical, the leading global developer of single-use, self-contained, illuminating medical devices. Trained at Stanford University and the University of California at Los Angeles (UCLA) School of Medicine, Dr. McConnell is board certified in Thoracic Surgery and currently serves as Director of Cardiac Surgery at Shasta Regional Medical Center, a 246-bed acute care, medical and surgical facility in Northern California.
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