by adenverd on 8/31/19, 9:51 PM with 121 comments
by throwaway911411 on 9/1/19, 1:02 AM
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.
by copperx on 9/1/19, 12:03 AM
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?
by DoreenMichele on 9/1/19, 6:30 AM
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.
by fencepost on 9/1/19, 5:22 AM
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/...).
by empath75 on 9/1/19, 12:02 AM
by andrewl on 9/1/19, 3:43 AM
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.
by jes on 9/1/19, 4:25 AM
by tomohawk on 9/1/19, 1:25 PM
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.
by buckminster on 9/1/19, 12:50 PM
by ijiiijji1 on 9/1/19, 1:51 AM
by orionblastar on 9/1/19, 2:57 AM
by hairytrog on 9/1/19, 12:09 AM
by crimsonalucard on 8/31/19, 11:57 PM
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.
by msandford on 8/31/19, 11:59 PM
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.