Dirty Instruments Pose Threat to Outpatients, Too

Earlier this year, both patients and providers were shocked when a rash of hospital patients got seriously ill or died after medical devices used to examine their gastrointestinal tracts infected them because they were not sufficiently cleaned after previous use. 

Now, it seems, inpatients aren’t the only ones who need to worry about contaminated medical instruments — according to an advisory issued by the Centers for Disease Control and Prevention ( CDC) and FDA, a wide range of reusable diagnostic instruments used in doctors’ offices and other outpatient facilities are vulnerable to the same risk of carrying other patients’  bacteria.

And last week, the FDA followed up that notice with a warning that bronchoscopes specifically can transmit infections if not adequately cleaned — 109 such adverse events have been recorded by the agency in the last five years, according to Bloomberg.com. Bronchoscopes are instruments inserted into the mouth or nose and through the windpipe (trachea) to examine the lungs’airways.

This widespread vulnerability to infection is especially worrisome, given that a couple of months ago, an FDA panel advised not banning the duodenoscopes that caused the outbreak that got so much attention because there’s no other option for treating certain life-threatening conditions. In other words, these are bad tools, but in some cases, the only ones.

So some people with certain conditions remain at risk if they have an endoscopic procedure, but those scopes aren’t the only ones of concern.

According to Medscape Medical News, the feds’ advisory was a strong consciousness-raising effort to get all clinicians and facilities to clean, disinfect and sterilize all reusable, invasive tools as if peoples’ lives depended on it … because it can. (The advisory specifically called for providers to test patients for whom they have used certain scopes for blood-borne pathogens, including hepatitis B virus and HIV.)

The feds didn’t cite specific examples of contaminated reusable medical devices, but a CDC spokesperson told Medscape that inspection of clinics operated by Kadlec Health System in Washington revealed “inconsistencies and potential inadequacies” in how reusable devices were disinfected and sterilized, and that the clinics had suspended some procedures as a result.

The Bellevue Clinic and Surgery Center of Seattle Children’s Hospital notified about 10,000 patients recently that they might be at risk for infection because of improperly cleaned surgical instruments dating to 2010; a community health center in Tucson, Ariz., told its dental patients earlier this year that they should be tested for possible infection after discovering that some equipment had not been sterilized; in Pennsylvania last year, a surgery center’s physicians didn’t perform high-level disinfection of sigmoidoscope components, nor sterilize various forceps.

Joseph Perz, an epidemiologist at the CDC’s Division of Healthcare Quality Promotion, told Medscape that improper cleaning of reusable devices “is not just associated with the hospital environment. Autoclaves are ubiquitous. They’re in doctors’ offices and clinics.”

An autoclave is a container in which chemical reactions, high pressure and high temperatures sterilize equipment. As Perz said, “We take it for granted, but people are using autoclaves without giving enough thought to doing every single step correctly.”

The federal advisory included instructions for medical personnel to follow proper cleaning procedures, and allow enough time for thorough disinfection. If you’re concerned about instruments your medical caretakers use, ask if:

  • the personnel responsible for disinfection have been trained not only when they’re hired, but annually, and whenever new equipment is introduced; ask if they’re required to demonstrate competency to their trainer;
  • the facility monitors and documents adherence to procedures for cleaning, disinfecting, sterilizing and storing reusable devices, and does it share the results with staff;
  • when the facility shops for a reusable medical device, it consults with its reprocessing personnel to ensure that infection control is considered in the purchase decision (some devices are more difficult to handle than others).

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