Cancelled Surgery

Hospital Forced To Cancel Surgeries For A Week Due to Contaminated Instruments On May 10, 2018, a hospital in Denver, Colorado, cancelled all surgeries for a week due to contaminated surgical instruments being found in the O.R. after reprocessing. This is just the latest case in a long line of reported cases of contaminated instruments being sent to the O.R. after they had been reprocessed. Far too many incidents like this have been in the headlines over that past several years. The problem of surgical instruments not being properly decontaminated, cleaned and sterilized prior to being returned for use on a patient, has been growing rapidly throughout the country. This problem was first addressed by the CDC in their September 11, 2015 Health Alert Advisory that stated: “The Centers for Disease Control and Prevention (CDC) and U.S. Food and Drug Administration (FDA) are alerting healthcare providers and facilities about the public health need to properly maintain, clean, and disinfect or sterilize reusable medical devices. Recent infection control lapses due to non-compliance with recommended reprocessing procedures highlight a critical gap in patient safety.”¹ Regretfully, even after this major Health Alert Advisory from the CDC, we have continued to see reports of contaminated instruments causing canceled surgeries, patient harm and even patient deaths. This most recent example occurred just last month. The full text of the NBC News report from Denver can be viewed here: https://www.9news.com/article/news/health/a-porter-adventist-patient-says-his-surgery-was-canceled-due-to-contaminated-tools/73-551131094 According to the report, the hospital said it identified a gap in the pre-cleaning process. The hospital also issued a statement saying the residue found on the instruments was a result of increased mineral content in the water which caused deposits and buildup on the instruments.  The hospital clarified that the water quality issue was separate from the gap in the pre-cleaning process.² Protecting patients from contaminated surgical instruments is the number one goal and mission of every CS/SPD department. As the September 2015 CDC Advisory stressed, non-compliance with the manufacturer’s recommended reprocessing procedures represents a critical gap in patient safety.³ Protecting your patients from harm caused by a contaminated instrument starts by following manufacturers’ published cleaning and reprocessing IFUs. Even more important than following the manufacturers’ published IFUs is to demand IFUs that have been validated by independent laboratory testing using AAMI and FDA test protocols. By only using instruments with validated IFUs you can have the documented assurance of providing clean, sterile, moisture-free instruments for every patient, every time! 1. Centers for Disease Control and Prevention Health Alert Advisory HAN00323, September 11, 2015. 2. NBC News 9, Denver, Colorado. 3. CDC Op. Cite.