How Clean Are The Surgical Instruments In Your OR?

It could never happen to you, right?

I was shocked to hear the NBC News investigation that revealed that there are increasing incidences of dirty surgical tools ending up in our ORs. How could this even happen?

We have all seen the used tools be whisked away from our OR back tables, specked with blood, bone and other bodily detritus, only to return the next time in the triple-packed sterilization packs. How could bacteria survive the process?

I never considered not trusting the process. Well, there was one time that I spotted something lodged between the tines of a retractor. What was it? I don’t know. It didn’t enter the operative field after I saw it and requested its removal from the Mayo stand and even the back table. Now I look back and ask: What had it already touched?

This medical investigation brought up questions I had never considered. How do we clean instruments before sterilization? Who does it? Are there safeguards in place?

At our facility, we do the World Health Organization-inspired OR checklist when we bring a patient into the room, ensuring that the right patient will receive the intended surgery at the correct site. But who would have thought that we needed to shine a light of investigation on the instruments laid out so beautifully for our use?

Do you assume that the nurses and technicians clean those instruments after your case? I did and I was wrong. In many cases, the work happens far from our sight, or anyone else’s for that matter, thanks to underpaid hourly workers without much training. It doesn’t help when we need that one special tool again after we dropped it on the floor and we need it stat!

Did you know that New Jersey is the only state that requires these sterile processing workers to undergo training? That is shocking.

I’m no fan of more governmental regulations but for the safety of our patients, and us, I would be willing to have the regulation of training for these processors. The Food and Drug Administration (FDA), when approached by NBC News, gave this statement: “Hospitals are reminded to carefully clean and sterilize reusable medical devices. A patient’s risk of acquiring an infection from a reprocessed medical device is very low.”

By the way, if you are saying, as I first did, that you weren’t aware of any negative outcomes from a poor processing, consider this fact: The FDA does not require hospitals to report dirty surgical instruments and only 25 states are required to report surgical site infections.

The Center for Public Integrity investigated and found many instances of dirty instruments leaving the processing sites. For instance, a video camera that examined 350 suction instruments found that all of them contained debris after sterilizing according to protocol.

This news makes you wonder. As physicians and surgeons, we are well trained. The OR staff members around us have years of training and certification exams as well. The weak link in this process is the underpaid members of the processing team, who are often housed in the basement of the hospital out of sight.

How does your hospital process instruments?