Spring Cleaning

Abstract

As a former clinical research scientist, I was shocked to find myself recently in an unfamiliar position: that of a hospital patient. Having never had an operation in my life, waiting for minor surgery caused considerable anxiety. Suddenly, I was less interested in the quality of the patient's surgical biopsy, and more interested in the tools to be used. Were they sterile? Were the hospital personnel having a good day? Would I make it through the anesthetic? And if I did, would I come down with hospital-acquired, flesh-eating bacteria afterward?As it turns out, my fears were not unwarranted. According to the U.S. Centers for Disease Control, approximately one out of every 20 hospitalized patients will contract a healthcare-associated infection, through the environment or via contaminated hospital equipment. Recent news reports have shone a spotlight on the hazards of incorrectly reprocessed medical devices such as arthroscopic shavers, cannulae, and endoscopes.The reprocessing of reusable devices is a multistep process, which if incorrectly carried out can result in contamination and infection. Recent breakthroughs in minimally invasive surgery have been made possible by the development of highly specialized, complex, and flexible surgical instruments, including robotic devices. Their moving parts and channels are a far cry from the relatively simple instruments in use decades earlier, and make these tools much harder to clean.In this issue of Horizons, experts in healthcare technology management, manufacturing, and regulation came together for a roundtable discussion on the broad issues and special challenges faced by sterilization and reprocessing professionals. Our Big Picture section also includes 10 tips that facilities can follow to improve reprocessing immediately.Confused about how clean is clean? Hospital sterile processing and FDA experts dissect cleaning verification, the composition and quantification of soils left behind in medical instruments, and the thorny problem of reprocessing implantable screws and plates in orthopedic tray sets. That's just a taste of what this comprehensive issue has to offer.Patient safety and the probability of contaminated instruments were indeed on my mind as I waited for surgery. However, when I woke up with a few tiny incisions (the operation used thin robotic arms), and no complications, I also remember being grateful, in the words of one of our authors, for “how fortunate we are to have such advanced tools, processes and facilities to ensure patient safety and survival.”I have no doubt that reprocessing issues and the challenges of following complex reprocessing instructions will be solved in the future, and indeed, concerted efforts are being made to do so. The only question is whether these issues can be resolved before my (or your) next surgery.