It’s called reprocessing. Most of the time, that
job is handled by technicians who, depending
on the hospital and state they work in, might
not have formal certification for what they do.
They might have a copy of the cleaning instructions, or they might not. They may be trying to
make sense of dozens of sets of instructions,
which can differ from manufacturer to manufacturer for the same kind of instrument.
You probably have never thought about the
people in those instrument cleanup crews, but
one day your life may depend on one of them.
“My staffers are all certified and many have
stayed with me for 20-plus years,” says Sue
Klacik, who oversees reprocessing at St. Elizabeth Health Center in Youngstown, Ohio. But
she notes that reprocessing jobs throughout
the country tend to have high turnover because
of the pressure and technical demands. Though
official figures on turnover aren’t available,
Jerzy Kaczor of Soyring Consulting, a company
that helps hospitals manage reprocessing,
notes that he recently worked with one hospital
in which half the techs left after a few years. In
other places, he says, turnover is even higher.
The concern isn’t just that reprocessing is
handled by a workforce that could earn almost
as much money as groundskeepers but with
less stress and a lower “yuck” factor. These
workers must also face challenges presented
by the new breed of devices themselves, many
of which have minuscule channels and crevices that can be impossible to see and difficult
to access. “When you use artificial materials,
all kinds of proteins and bacteria stick to the
surface,” says Christopher Jobe, M. D., a professor of orthopedic surgery at Loma Linda University. Case in point: Dr. Jobe’s 2006 study
found protein remnants on the tiny bone shavers commonly used in orthopedics.
“Picture yourself washing dishes while wearing Playtex gloves, and trying to disassemble
something that has very small moving parts,”
says Ramona Conner, M.S. N., of the Association
of Perioperative Registered Nurses.
Even the most dedicated technicians scratch
their heads as they attempt to follow cleaning
guides that can be either too detailed or not
detailed enough. “There is a large variability in
the instructions from the different manufac-
Between you and the guy who just left
the table, somebody has to clean up.
“Hospital-acquired infections are killing about
300 people a day in the U. S. That’s like crashing
a passenger jet every single day,” says Edmond
Hooker, M. D., who studies health services at
Xavier University. The rates of central line infections (from bacteria, often staph, in the bloodstream) and catheter infections are a good
indicator of overall cleanliness, Dr. Hooker
says. To check, go to hospitalcompare.hhs.gov,
select a hospital, and click on “Readmissions,
Complications & Deaths.” —LAURA ROBERSON
Know Before You Go
turers for very similar devices,” says Linda
Condon, R. N., the educator for the reprocessing
department at Johns Hopkins Hospital in
Baltimore. And sometimes, she says, cleanabil-
ity seems like an afterthought to design. Sur-
geons at Condon’s hospital recently bought a
remote control for some of their arthroscopic
instruments. “The cleaning instruction for the
remote was one sentence: ‘Use a neutral deter-
gent and wipe it clean.’ So I was like, ‘ Wow,
okay, can I submerge it? Can I soak it? Can I
scrub it?’ It took me 30 days to get an answer
from the manufacturer.”
What all this means about your next doc-
tor’s visit is hard to say. Cleaning lapses are not
so rampant and dangerous that you should
avoid surgery you need or cancel your next
appointment. Experts say the risk of infection
from a dirty medical instrument is low. Con-
sider the context: A hospital with a few hun-
dred beds probably turns around 10,000 to
13,000 instruments a day. Condon estimates
that a large teaching center like hers may
handle more than double that number. The
FDA, which oversees medical devices, noted in
a written statement that “harder to clean does
not mean a device cannot be cleaned.” (The
agency declined a request for an interview.)
The trouble is that no one knows how often
soiled instruments make their way to patients.
No statistics exist because hospitals aren’t
required to notify the government when they
discover a dirty device; also, they may feel
pressure to hide the problem for fear of bad
hospital ratings, bad publicity, and lawsuits.
“How frequently are lapses in reprocess-
ing occurring? Honestly, we really don’t
know,” says the CDC’s Melissa Schaefer, M.D.
“The reports that we hear about are potentially
the tip of the iceberg.”
In Dr. Schaefer’s 2010 study, published in
the Journal of the American Medical Associa-
tion, 28 percent of the ambulatory surgical
centers studied had strayed from their clean-
ing protocol to some degree. And a new Uni-
versity of Michigan study that analyzed the
cleanliness of 350 suction tips (which are
used to vacuum up fluids during surgery)
