Here There and Everywhere

Expat wanderer

You Think Your Clean American Hospital is Safe?

We’ve long believed one of the ways to stay healthy is to stay out of hospitals as much as possible. A horrifying report I found on AOL Everyday Health:

Dirty Surgical Tools: A Hidden, Deadly Danger
A new report suggests that doctors all over the country are using medical instruments contaminated with blood, tissue, and other debris. Could the same devices that save your life also put it at risk?

THURSDAY, Feb. 23, 2012 — When John Harrison checked into Methodist Hospital in Houston, Texas, to have routine surgery for a damaged rotator cuff, he was told he’d need, at most, a one-night stay in the hospital followed by a few weeks of physical therapy. Seven follow-up operations and two-and-a-half years later, however, his shoulder is worse off than it was before, and Harrison, frankly, is lucky just to be alive.

Shortly after his initial surgery in 2009, the 63-year-old began experiencing severe pain and discomfort around the site of his scar, which had turned bright red and was oozing thick fluid. Doctors reopened him up to determine the problem — and found that an infection had eaten away part of the bone and set loose the screws and sutures they had placed just weeks earlier.

A Hidden Danger in the OR

Harrison’s case, unfortunately, was not an isolated one. Within days, at least six other joint surgery patients at Methodist developed similarly serious infections, leading to a temporary shutdown of the hospital’s operating rooms while officials from the U.S. Centers for Disease Control and Prevention (CDC) probed for a cause.

They found what they were looking for, and then some, in two commonly used surgical tools: an arthroscopic shaver and an inflow/outflow cannula. Both contained human tissue and bone, despite having been thoroughly cleaned after every procedure — a discovery that suggested the problem might be bigger than just one hospital in Texas.

In fact, according to a new report by investigative journalist Joe Eaton of the Center for Public Integrity, a nonprofit that focuses on ethics and accountability, dirty medical devices are a widespread and potentially deadly threat to your health. In 2008, Eaton notes, a hepatitis C outbreak in Las Vegas revealed that a local outpatient surgery center was working with contaminated tools, some of which were intended for only single use anyway. This, in turn, led to an inspection of 1,500 other such centers — and the finding that 28 percent of them had “infection control deficiencies related to equipment cleaning and sterilization.”

But that’s not even the worst of it. In 2009, the Department of Veterans Affairs admitted that improperly cleaned endoscopes had been used on more than 10,000 vets, some of whom later tested positive for HIV or hepatitis. It’s difficult to know for sure how many of those infections (if any) resulted from the dirty instruments, but experts say the risk is higher than most people realize.

“The cases we hear about,” CDC medical officer Melissa Schaefer, MD, told Eaton, “are only the tip of the iceberg.”

Whose Fault Is It, Anyway?

It would be easy to blame hospitals for this potentially deadly danger (and in some cases, we should), but Eaton says the problem is more complicated than it looks.

For one thing, research shows that sterilization instructions from manufacturers are often not up to industry standards. In a study presented last summer at a workshop for the Food and Drug Administration (FDA), scientists at the University of Michigan Health System ran a tiny video camera inside 350 “surgery-ready” suction tips and found that every one contained traces of blood, bone, tissue, and rust. Even more disturbing, however, was the fact that all but seven still contained debris after the team put the tools through the recommended cleaning and disinfection processes.

“I don’t know who approved this or who made this a reusable item, but this is not a reusable or cleanable item,” said lead researcher Jahan Azizi, a risk management clinical engineer at the University of Michigan, referring to one of the suction tips. Azizi blames the proliferation of dirty instruments on poor product design and manufacturing — but experts say there are many other factors to consider as well.

Among them, Eaton reports, is that as tools become more specialized and intricate, so too do their cleaning needs. There are added parts to sterilize, smaller channels to unclog, different materials to wield — you can’t just blast everything with a heavy shot of hot steam and move on.

“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.”

That process needs to be regulated, industry vets say — but by whom?

The Need for Action

According to Eaton, most sterilization of surgical instruments takes place in hospital basements, where underpaid employees work in less-than-ideal conditions to keep equipment in rotation, sometimes cleaning as many as 40,000 tools a day. Technicians are under a vast amount of pressure to do their jobs both quickly and well, which leads to high staff turnover and a frenetic atmosphere that lends itself to mistakes.

Mary Olivera, director of sterilization at a New York City medical facility and past president of the New York State Association of Central Service Professionals, thinks these issues could be addressed if central sterile techs were required to be certified to work in medical facilities. (Currently, only New Jersey mandates professional certification in the field.)

“The people who do your nails, they have to take an infection control course before they can apply for a license,” Olivera told Eaton. “Same with a dog groomer. Yet the people who deal with lifesaving equipment, they are required to have zero education.”

Olivera is among a group of people who have been pushing for legislation to regulate sterilization workers, but as she and her colleagues are finding out, change is easier said than done.

In July of 2009, after the CDC’s Methodist investigation, the FDA launched a safety review of arthroscopic shavers. Findings from the review have not been made public, but insiders say the results are “scary” and show serious potential for patient harm. Years later, however, the agency still has not taken any additional action to address the problem, save an alert on its Web site encouraging facilities to assess the effectiveness of their cleaning procedures.

“These are important products that have been used for decades with little evidence of risk to public health as a result of reprocessing,” FDA spokeswoman Karen Riley said by way of explanation. “In 2010, there were 2.1 million arthroscopic procedures of the knee performed and yet total adverse events from all causes was one percent. This does not merit withdrawal of a valuable device.”

John Harrison might disagree. Nearly three years after going under the knife for a “routine” operation, he can’t even raise his right arm to scratch an itch on his head. And the damage isn’t just physical.

“It’s changed my life,” he told NBC News. Every aspect of it.”

February 23, 2012 Posted by | Health Issues, Hygiene, Living Conditions | 3 Comments

Just a Little Less Alien

It’s great having friends who all returned to the USA after our years of living in Qatar (and Kuwait) so we can share our experiences, our frustrations, our challenges. It’s been two years for me since AdventureMan and I made the big decision to retire, and in Pensacola, not Edmonds, WA.

Pensacola is a pretty cool place to be retired. One of the best things, after living in Kuwait especially, is the traffic. People might complain, but the traffic here is laughable. It’s very calm. Traffic might be waiting two lights at a stoplight, but hey – people wait, don’t just drive right through. No one has ever pushed me into a round about, or anywhere else, unlike Qatar, when I got in some young man’s way, and he pushed me out of his way (!)

When you go to the symphony, or to church, or to aqua aerobics, in the worst traffic it might take ten minutes. There are restaurants everywhere, many of them pretty good. The worst restaurants are usually better, cleaner, faster than most of the restaurants in Kuwait and Qatar. The only cuisine we have not been able to find here is Ethiopian, and we can drive to Atlanta or New Orleans and get that.

It’s been two years . . . there is something in me that starts getting a little restless, starts looking at my household goods with an eye to getting rid of, giving away, cutting down on weight. At the very least I might have to paint something, or change the furniture around . . .

My friends are suffering many of the same challenges, the challenge of being an expat back in the USA. What was formerly comfortable is not such a good fit anymore; we have changed, and we are trying to cobble together lives that can accomodate the changes.

I had a minor triumph; I realized that after two years, I am starting to have people I can go sit with when I walk into a crowded venue. It may sound like a small thing, but the fear of having to sit alone in a crowd where everyone is visiting and sharing is a little daunting. Who wants to look pathetic?

But my expat friends and I laugh; in expat world two years makes you an old-timer. When new people come in, you are expected to show them around, show them where (and how) to shop for things, where to get things fixed, altered, where to go to pay your bills and how to pay them. Two years makes you and old hand, often with one foot out the door, getting ready for the next posting or contract.

Three of my friends went back to their home locations, only AdventureMan and I settled in a new place. While I am making some progress, two years in, I still wonder who my friends will be? Will I ever feel at home in Pensacola?

February 23, 2012 Posted by | Adventure, Community, Cross Cultural, Eating Out, Entertainment, Family Issues, Friends & Friendship, Living Conditions, Moving, Pensacola | 9 Comments