5 ms·

Why don't the medical tools get reused? That seems absolutely insane to me.

pkrein 13y ago
http://abcnews.go.com/Health/rogue-dentist-exposed-7000-patients-hiv-hepatitis/story?id=18834611#.Uaznj2Q4VZE http://abcnews.go.com/Health/rogue-dentist-exposed-7000-pati...
ianstormtaylor 13y ago
Yeah I also don't get that. Would they not be able to just be disinfected and resealed?
- dragonwriter 13y ago
  > Would they not be able to just be disinfected and resealed? Blades that need to be very sharp and of very particular dimension are going to need sharpened, which is going to change their dimensions. So there is limited, if any, reusability in any case. And the keeping, transporting to a cleaning facility, cleaning, sharpening, etc., is going to come with an additional cost cost and risk of accident that you don't have with immediate disposal.
- Fomite 13y ago
  Some can be, some can't be. Many simple, common-place tools are remarkably hard to clean. In a battle between "Lets save money" and the risk of a healthcare-associated infection, both economics and clinical ethics sides on tossing the tool.
apendleton 13y ago
Some do, and it appears he was only billed for the ones that don't. For blades and other sharp things, it's probably cheaper to just use new ones than to have the equipment and staff to sharpen old ones. Some of the other stuff, I suspect, isn't autoclave-able, which is the standard for sterilizing surgical stuff. That pretty much precludes reuse of plastic things, for example.
gojomo 13y ago
It's very hard to be sure of removing all viruses and prions from a surface... especially if that surface is porous or worn-down from any use. Deep, long superheating might do it... but that itself can wear or destroy many materials, and the item would need to be kept in 'like-new' sterilization until next use. Hospitals might not be the best place to try to do that; in 2002 there were about 30,000 deaths in the US due to hospital-acquired bloodstream infections, per the study referenced at: http://en.wikipedia.org/wiki/Hospital-acquired_infection#United_States http://en.wikipedia.org/wiki/Hospital-acquired_infection#Uni...
hga 13y ago
I've heard from someone who was involved in this that sterilizing medical equipment that you can't autoclave is seriously non-trivial. And certainly not free, nor is autoclaving, including the inevitable human errors that will result in incompletely sterilized equipment, plus there are all sorts of tradeoffs made here. I'm just old enough to have had glass syringes used on me, they're thick, heavy and obviously much more easily broken, which is less than ideal for taking blood and the like. One other advantage of disposables: you can more afford to stock up a lot in case you need to surge after a disaster, they'll get used in the normal course of operations. Whereas the reusable stuff is generally/always? more expensive up front.
- jonknee 13y ago
  Metal tools seem quite simple to autoclave. That said, they should also be pretty cheap to make (unlike the $900 knife in the article).
  - knifeySpooney 13y ago
    Okay, but for various sharps, blades and other cutting tools, keep in mind that repeatedly heating and cooling innately dulls them. Taking metal through temperature ranges that result in expansion and contraction mess with the honed edge. Think about metal as if it were a malleable wax candle. Not to mention that mere pressure against skin on a cutting edge effectively bends and dents the edge until it becomes dull. That's what happens to IV needles, just the pressure to pierce skin alone ruins the point. How many times do you get to re-use a safety razor after shaving your beard or legs/armpits? Was the activity really very stressful on the blade? And yet, maybe you'll get 5 passes (with a multi-blade razor on a thick beard) before it's pulling at the hair and skin, and you notice it's painful to shave with. So too with surgical tools. After so many cycles of cutting, then heating and cleaning, you're pressing a dull butter knife against skin and whatever else you're cutting, relying more on cutting by sheer pressure than using the sharp edge to separate the tissue. And then you can't stop the bleeding because the cut was wrong, the patient dies, you get sued (you DO get sued), and maybe you lose your license, reputation, time and money. So balance it against, just buying a $900 object brand-new. But, yeah, how about sharpening them again? But with what? An angle grinder plugged into an extension cord? A stone wheel down in the metal shop? Not quite... I really don't know all that much about cutlery, but getting a blade perfectly sterile after sharpening it is probably something that is best done by automated factory machines, at which point the blade may as well be new anyway.

http://abcnews.go.com/Health/rogue-dentist-exposed-7000-patients-hiv-hepatitis/story?id=18834611#.Uaznj2Q4VZE http://abcnews.go.com/Health/rogue-dentist-exposed-7000-pati...

ianstormtaylor 13y ago

Yeah I also don't get that. Would they not be able to just be disinfected and resealed?

dragonwriter 13y ago
> Would they not be able to just be disinfected and resealed? Blades that need to be very sharp and of very particular dimension are going to need sharpened, which is going to change their dimensions. So there is limited, if any, reusability in any case. And the keeping, transporting to a cleaning facility, cleaning, sharpening, etc., is going to come with an additional cost cost and risk of accident that you don't have with immediate disposal.
Fomite 13y ago
Some can be, some can't be. Many simple, common-place tools are remarkably hard to clean. In a battle between "Lets save money" and the risk of a healthcare-associated infection, both economics and clinical ethics sides on tossing the tool.

apendleton 13y ago

Some do, and it appears he was only billed for the ones that don't. For blades and other sharp things, it's probably cheaper to just use new ones than to have the equipment and staff to sharpen old ones. Some of the other stuff, I suspect, isn't autoclave-able, which is the standard for sterilizing surgical stuff. That pretty much precludes reuse of plastic things, for example.

gojomo 13y ago

It's very hard to be sure of removing all viruses and prions from a surface... especially if that surface is porous or worn-down from any use. Deep, long superheating might do it... but that itself can wear or destroy many materials, and the item would need to be kept in 'like-new' sterilization until next use. Hospitals might not be the best place to try to do that; in 2002 there were about 30,000 deaths in the US due to hospital-acquired bloodstream infections, per the study referenced at: http://en.wikipedia.org/wiki/Hospital-acquired_infection#United_States http://en.wikipedia.org/wiki/Hospital-acquired_infection#Uni...

hga 13y ago

I've heard from someone who was involved in this that sterilizing medical equipment that you can't autoclave is seriously non-trivial. And certainly not free, nor is autoclaving, including the inevitable human errors that will result in incompletely sterilized equipment, plus there are all sorts of tradeoffs made here. I'm just old enough to have had glass syringes used on me, they're thick, heavy and obviously much more easily broken, which is less than ideal for taking blood and the like. One other advantage of disposables: you can more afford to stock up a lot in case you need to surge after a disaster, they'll get used in the normal course of operations. Whereas the reusable stuff is generally/always? more expensive up front.

jonknee 13y ago
Metal tools seem quite simple to autoclave. That said, they should also be pretty cheap to make (unlike the $900 knife in the article).
- knifeySpooney 13y ago
  Okay, but for various sharps, blades and other cutting tools, keep in mind that repeatedly heating and cooling innately dulls them. Taking metal through temperature ranges that result in expansion and contraction mess with the honed edge. Think about metal as if it were a malleable wax candle. Not to mention that mere pressure against skin on a cutting edge effectively bends and dents the edge until it becomes dull. That's what happens to IV needles, just the pressure to pierce skin alone ruins the point. How many times do you get to re-use a safety razor after shaving your beard or legs/armpits? Was the activity really very stressful on the blade? And yet, maybe you'll get 5 passes (with a multi-blade razor on a thick beard) before it's pulling at the hair and skin, and you notice it's painful to shave with. So too with surgical tools. After so many cycles of cutting, then heating and cleaning, you're pressing a dull butter knife against skin and whatever else you're cutting, relying more on cutting by sheer pressure than using the sharp edge to separate the tissue. And then you can't stop the bleeding because the cut was wrong, the patient dies, you get sued (you DO get sued), and maybe you lose your license, reputation, time and money. So balance it against, just buying a $900 object brand-new. But, yeah, how about sharpening them again? But with what? An angle grinder plugged into an extension cord? A stone wheel down in the metal shop? Not quite... I really don't know all that much about cutlery, but getting a blade perfectly sterile after sharpening it is probably something that is best done by automated factory machines, at which point the blade may as well be new anyway.