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Filthy surgical instruments: a threat in America's operating rooms (2014)
- crimsonalucard 7y agoMakes sense that hospitals would do this in the United States. It's a cost problem. Simply put, hospitals do not have the financial resources to fully clean their tools. Last year I was in the hospital for 1 day and it cost me $10,000. What a travesty. How can doctors ever properly wash surgical tools with that paltry amount of money? Doctors and hospitals deserve better.
- empath75 7y agoThey have to pay the staff that chases down delinquent patients for fraudulent charges, too, you know.
- HarryHirsch 7y agoIs this irony or not? After all everyone knows that it's the hospitals that send the fraudulent bills. Right now: ER visit, didn't have insurance details on me. Hospital sends full-fare bill. I send insurance details via certified mail because it happened before. Hospital sends full-fare bill. It's always like that. They do this to prey on the elderly and disorganized.
- oh_sigh 7y agoI've wondered how much time and money Americans spend on rectifying billing problems between health care providers and their insurance. I imagine(with only anecdotal evidence) it might be greater than the amount of time and money Americans spend on needlessly complex tax filings.
- joe_the_user 7y agoHospitals are extraordinary profit centers for their owners - vast amounts of money go through them. If they can't clean their surgical instruments, the situation is morally and, uh, literally, criminal. Whoever is ultimately responsible for such situations - managers, not underlings - should be in jail.
- corndoge 7y agoIt is sarcasm
- crimsonalucard 7y agoNah man, I think he picked up on it.
- joe_the_user 7y agoI didn't, I was reading quickly but whatever. I'm on HN as a site where content rather than whether you get the jibe is important.
- rayiner 7y agoThey are not: https://www.healthcaredive.com/news/hospital-operating-margins-dropped-39-over-3-years/532205/ https://www.healthcaredive.com/news/hospital-operating-margi... > A new Navigant study analyzed for-profit and nonprofit provider networks and found that the average operating margin declined by almost 39% over the same time span, from 4.15% in 2015 to 2.56% in 2017. Contrary to your assumption, hospitals are about as profitable as grocery stores. It would be useful to introspect about that a bit, because I imagine many people have similar misconceptions. What was your assumption that hospitals are “extraordinary profit centers” based on? Do you think peoples’ attitudes toward hospitals might change if they knew the real facts? Does the truth change your attitude about who should go to jail?
- Ididntdothis 7y agoBe careful with these numbers. As far as I know they operate more like a lot of non-profits around DC. Big money for insiders and leadership, but no profit at the end of the year.
- rayiner 7y agoFor-profit hospitals have shareholders who should ramp down on such waste, but they don’t appear to have appreciably higher profit margins.
- bcrosby95 7y agoYep. And $25,000 for 1 hour of a surgery room. And $20,000 for 1 hour of a recovery room. Practically poverty levels.
- HarryHirsch 7y agoYou wonder how veterinatians manage. A few years ago, the cat had to go in for dental treatment. Chronic gingivitis, known problem in the feline, removal of teeth is indicated. Several hours of surgery under general anesthesia, two or three people are involved. Bill comes to 700 dollars. How far do 700 dollars get you in the hospital? The handshake with the anesthesiologist is already more expensive!
- rscho 7y agoVeterinarians manage because they are far less specialized than docs for humans. Also, there is less demand for potentially lifesaving but financially ruining treatments.
- bcrosby95 7y agoI wonder the same with dentists too. I had two wisdom teeth removed and it costed just as much as my sister getting a doctor to remove a cotton ball from her ear (while waiting in line). One involved surgery and anesthesia. The other involved a pair of tweezers. Same price.
- natalyarostova 7y agoYou are paying for a bunch of other people who used their ER but didn't pay, while the gov still forces the hospital to treat them.
- deleted 7y ago[deleted]
- Ididntdothis 7y agoMost people have no idea how much big houses and sports cars cost either. A while ago my girlfriend paid $30000 facility fee for a 5 hour stay. Plus several $10000 more for surgeon, anesthesiology and others. Who could live on that? Add: Some people here don't seem to understand sarcasm.
- war1025 7y agoYou're getting downvoted to hell, but I heartily approve of your cynicism.
- zaroth 7y agoYou think it’s expensive now? Just think how expensive it would be to “properly” clean all the reusable tools. “In 2010, there were 2.1 million arthroscopic procedures of the knee performed and yet total adverse events from all causes was 1 percent.” That’s all causes, not even 1 percent caused by contamination specifically, and does not tell us anything about how severe the AE was. So yes by all means we should be testing cleaning instructions in real-world conditions and make sure instructions are clear and clearly followed. But articles like this are part of the reason that hospital stay costs $10,000 in the first place.
- msandford 7y agoWhen you want to race automobiles but you aren't an F1 driver there are leagues that will accommodate you. But not everyone is equally rich. How do you ensure that it's driving skill that determines the winner, rather than who is willing to spend more money on a better car? You make a rule that says there are no rules about how much a car can cost, but that anyone can buy the winner's car at the end of a race for $X. I can't help but think that a similar law might not be helpful. Make doctors and hospital administrators randomly subjected to these devices in a mostly-not-invasive procedure where sterile water is flown over the devices and then onto a finger-prick. In both cases making people have true skin-in-the-game is the solution to the problem.
- knolax 7y agoSo now we have filthy instruments and dead doctors?
- the_pwner224 7y agoThat would have potentially serious permanent and irreversible consequences. It's much different from losing $200k by having to sell your car at the end of the race. And there are various factors that affect the sterility of the instruments, some of which are out of the doctors' control. It is not OK to give a doctor HIV just because the maintenance people didn't service the machine correctly, causing it to output clean-looking but infected instruments.
- 7y ago
- empath75 7y agoI imagine that routine use of antibiotics after surgery is covering up for a lot of this and is also contributing to antibiotic resistant bacteria showing up in hospitals with greater and greater frequency.
- copperx 7y agoI don't think giving antibiotics after surgery as a rule is a modern invention.
- connicpu 7y agoUsing dirty tools isn't a new thing either
- bumby 7y agoAccording to The Checklist Manifesto, antibiotics should routinely be administered just before surgery for this reason and has shown large reduction in mortality rates
- brianpgordon 7y agoAre you saying that after-surgery antibiotics can't be a cause of antibiotic resistance because we've been giving antibiotics for a long time? It takes on the order of decades for antibiotic resistance to be selected for enough that it becomes a problem. And the first antibiotic wasn't even discovered yet a hundred years ago.
- copperx 7y agoEven if post-surgery antibiotics were the prime contributor to antibiotic resistance, arguing against the practice is disingenuous because there is no viable alternative.
- copperx 7y agoIt's unsettling to learn that a life-saving surgery can compromised by a tech who didn't spend a few extra minutes cleaning the tools properly. I had read that surgeons were moving into using disposable instruments because of the possibility of prion contamination (prions can't be destroyed by an autoclave). But maybe that was only for neurosurgery?
- chongli 7y agoFor such life-and-death critical jobs involving routine and mundane steps, we would be wise to employ a memory aid system. One good example is the way Japanese rail-workers wear white gloves and point at things [1] as they complete their routine checks. [1] https://www.atlasobscura.com/articles/pointing-and-calling-japan-trains https://www.atlasobscura.com/articles/pointing-and-calling-j...
- DoctorOetker 7y agoI also remember since a long time knowing that the surgical tools themselves were disposable (the price for a little bit of steel is nothing compared to the value of the operation for example), perhaps they mean the tool holders or more complicated instruments that hold the tools?
- deleted 7y ago[deleted]
- rscho 7y agoMost surgical instruments are absolutely not disposable. I don't think you can realistically represent yourself how much increase in healthcare costs that would imply. We are talking billions.
- throwaway911411 7y agoFor neurosurgery, when operating on a patient with suspected prion disease, the surgery will be done with disposable instruments as much as possible. This may mean however that the surgeon will have to use a hand drill, instead of a power drill. For the other cases without prions, normal sterilization works. And you don’t want to throw away all your equipment after each surgery. A neurosurgical power drill can cost around $20,000 - $40,000
- hairytrog 7y agoConsidering the amount of antibiotics used, doctors could probably use tools fished out a dumpster.
- teddyh 7y agoAntibiotics does nothing against viruses.
- eukaryote31 7y agoOr prions, or toxins (i.e botulinum)
- throwaway911411 7y agoA few observations from the article from a surgeon’s perspective . First of all, I agree with the article that sterilizing modern equipment is more difficult. Back when you just had steel equipment, you could just throw them in an autoclave and be sure that they were sterile (with the exception of prion diseases). As the article mentions, a lot of equipment can’t take that kind of treatment and or has areas that are had to access such as long channels. In additions, not all surgeries are created equal with respect to infection risk. Joint surgeries are some of the highest risk for infection. In fact, when doing open joint surgery, orthopedic surgeons will wear what looks like a space suit with helmet and air supply and work under a giant air suction device to keep the would from being contaminated. Add to that, that they were putting in foreign materials in the form of screws, and you have a recipe for disaster if there is the tiniest bit of contamination. As I have told my patients and medical students, a surgical infection is a life altering event. There is a good chance that you will never be the same after experiencing it. I think this type of thing will be a bigger issue as we move forward. Surgical equipment is getting more intricate and more expensive. Everybody is pushing to cut costs. Having less equipment for a hospital is less capital costs, but more times that it needs to be properly cleaned, and every time you clean is an opportunity to screw up. I think the ultimate answer might be taking the responsibility of sterilizing complex surgical equipment from the hospital to the manufacturer. Basically, the hospital would use the equipment once and send it back for reprocessing back to the manufacturer. For a lot of these surgeries, the manufacturer representatives are there at the hospital for surgeries requiring single use stuff likes screws, rods, artificial joints, etc so this would just add to the stuff they are bringing to the hospital anyway. It would be much easier for the FDA is o monitor and regulate a few reprocessing centers instead of every hospital. Simple equipment that you can just throw in an autoclave, can still be done by the hospital. Doing this would also force the manufacturers to think more about ease of cleaning since they would be the ones responsible directly for it. Just my 2 cents.
- nickles 7y ago> As I have told my patients and medical students, a surgical infection is a life altering event. There is a good chance that you will never be the same after experiencing it. What is it that makes such an infection is so impactful? Is there physical damage that persists, psychological trauma due to the experience, or some other factor? Edit: Read the comments prior to reading the article. > When Harrison awoke from that surgery, he imagined his nightmare was over. But in reality, it had just begun. Since then, what began as a simple operation has turned into a lengthy struggle that left him for months at a time dependent on hired nurses, unable to dress himself, take a shower, or work, and afraid for his life.
- ijiiijji1 7y agoCandida auris is so persistent autoclaving, hydrogen peroxide and bleach aren't effective... hospitals have had to resort to binning equipment and removing wall tiles. Imagine the hospitals / ORs that are are less fastidious, and in the US, hospitals aren't required to release statistics on preventable infections and deaths.
- orasis 7y agoGlad to see Hacker News is now peddling in clickbait fear trash.
- orionblastar 7y agoThere is software that handles that issue. I wrote some in 2002 that uses bar codes and tracking to see what instruments need cleaning. We invented a lot of the tech involved with it into a Windows 98 Javalin touch screen. I migrated the database from Excel to Access and SQL Server to speed things up. Other companies had similar products but not GUI at the time.
- andrewl 7y agoThis is an important article. I read several years ago about manufacturers sterilizing medical tools with radiation before they left the factory. I could imagine that the setup for doing that is too complex and dangerous for a regular hospital to run, but could it be offered as an outside service? Tools that can't undergo autoclaving could be sent out for irradiation after every surgery. But this is very much not my area, so there are probably a hundred things wrong with my suggestion that I'm too uneducated to see.
- ChuckNorris89 7y agoGood point. Couldn't Gamma radiation kill what heat alone won't? Edit: Did some research, Gamma radiation can't kill prions. That's one though SOAB.
- totallynotcool 7y agoThe issue is trust/verification during transport. Were temp/humidity kept in check? What was the biological lot number? Model of the machine that read the biological? Temp sterilization/dry time? Granted you could have a database and hospital customers could retrieve that information from there but what happens when they can't? There are definitely places where the SPD process could be improved but outsourcing isn't a very handsome one.
- jes 7y agoOn the question of sterilizing prion-contaminated surgical instruments: https://consteril.com/prion-sterilization-guide/ https://consteril.com/prion-sterilization-guide/
- goblin89 7y agoI’m half-expecting any sterilization guide dealing with prions to be an empty page with huge “Dispose of and ensure it’s never ever used again”. The article by Consolidated Sterilizer Systems does reference an Oxford Journal’s opinion that there is no method of prion decontamination or sterilization that has proven 100% effective. Interesting fact: Consolidated Sterilizer Systems is in the business of selling autoclaves, and at the end of the article there’s their lead collection form. It’d be very unfortunate if future shows that financial interests of conventional sterilization equipment makers played a part in delaying the establishment of effective prion contamination management practices (which may or may not involve disposable instruments—being not an expert myself, I can only speculate).
- fencepost 7y agoNote that the article is from 2012, with some level of update in 2014. It would be interesting to see whether these findings led to any improvements, although there's a good chance that many of the same individual pieces of equipment are still in use. In also curious whether some of the changes in Medicare reimbursement rates for return visits made any difference since they were targeted specifically at unplanned returns and complications (Modifier 78, https://www.emblemhealth.com/Providers/Claims-Corner/Coding/Global-Surgery-Reimbursement-Policy-Concerning-an-Unplanned-Return-to-the-Operating-Room https://www.emblemhealth.com/Providers/Claims-Corner/Coding/...).
- totallynotcool 7y agoMany shavers can be ran through a washer now which is great, but until they can be submerged in an ultrasonic cleaner these issues will remain. I'm a huge proponent for sterile handpieces and disposable inserts; doesn't really work in this case as the 'blade' for the shaver is disposable.
- DoreenMichele 7y agoI think it was a book called "The Hot Zone" that talked about ebola and similar diseases. It also said the village elders in rural Africa stopped the spread, not the well-educated, monied foreigners from more developed countries. They barricaded the roads and only let locals come in. They told their people "Don't go to the white man's hospital." because you would go to the hospital for a fixable problem, like a broken leg, and die of ebola contracted at the hospital. They quarantined the sick. You couldn't leave your hut. They would leave food on your doorstep to provide care. If three days food accumulated, they burned the hut down without verifying if you were dead or alive. Antibiotic resistant infections and the like are partly a product of our modern mentality that tech can fix anything. Often, it can't. Old fashioned procedures still have their uses and we don't rely upon them enough.
- a_t48 7y agoThe solution for stopping infectious diseases is to let anyone who contracts one die? You're not completely wrong, but I'll take my odds with modern medicine.
- DoreenMichele 7y agoThat's a wildly uncharitable interpretation of both my comment and the active efforts of village elders to stop the spread of an extremely deadly infection that had no known effective treatment at the time.
- buckminster 7y agoI'm surprised the patient went weeks without getting treatment for an obviously serious infection. When a friend had her knee replaced she received detailed instructions on recognising infections, including taking her own temperature twice a day, so it could be treated before it had any time to develop.
- tomohawk 7y agoTrust but verify. Without independent verification, this is exactly the type of result that is expected. If the manufacturers are not out in the field inspecting the devices and how they operate, how will they improve their designs in beneficial ways? If the government regulators are not doing spot inspections of the equipment, how do they know they haven't made a mistake in approving something, or that a hospital has not trained people properly, or whatever? If you're a patient, faced with these failures on the part of the regulators, the hospitals, and the manufacturers, what do you do? The whole system has failed here.