Non-VA hospitals are double-checking their inspection procedures to avoid contaminated endoscopic equipment.

NOTE from Larry Scott, VA Watchdog dot Org ... Speculation has run rampant on the possibility of contaminated endoscopic equipment in the civilian health care sector since the problems at VA facilities become public.  We may never know the extent, but we know they are tightening up their cleaning and inspection procedures.  All contaminated equipment information is here.

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Infection concerns spur more checks of medical equipment

Inspections at 3 VA hospitals in South reveal improper disinfection

By Liv Osby
Health Writer

Spot inspections at three Veterans Administration hospitals last month revealed that instruments used in colonoscopies and endoscopies were not properly disinfected, potentially exposing veterans to HIV and hepatitis.

Nearly 11,000 veterans tested at hospitals in Georgia, Florida and Tennessee were notified they were at risk of these infections, according to Dr. John D. Daigh Jr., assistant inspector general for health-care inspections at the VA, who testified before the House Veterans Affairs Committee last week.

This kind of reusable medical equipment and other instruments are used at hospitals, outpatient surgery centers and clinics everywhere. But what measures are in place to ensure the safety of patients undergoing these procedures?

In South Carolina, the state Department of Health and Environmental Control inspects 100 hospitals and 75 outpatient surgery centers and clinics for the federal Medicare program, said spokesman Thom Berry. These inspections are typically conducted every three years — more often if necessary, he said.

Berry said the federal Center for Medicare and Medicaid Services will soon increase the number of facilities to be checked annually, and that inspections at outpatient centers will be enhanced.

And while DHEC requires facilities to have policies for handling, cleaning and replacing reusable equipment, it does not set specific protocols for doing so, he said. And there are no inspections of the instruments themselves, he said.

“When we do our inspections,” he said, “we look to ensure (facilities) have a specific plan and that they train staff to follow it.”

CMS spokesman Peter Ashkenaz said the new regulations are aimed at reducing infections. CMS has $10 million in stimulus funds states can apply for to hire inspectors, he said. Berry said DHEC, with 14 inspectors and hit hard by budget cuts, plans to apply.

Most hospitals also are inspected by a national accreditation organization. One of them, the Joint Commission, inspects every 18 to 39 months. Another, DNV Healthcare, inspects yearly.

The Joint Commission doesn't keep data on how often hospitals are cited for violating disinfection standards, spokeswoman Elizabeth Zhani said. But a listing of the top 10 standards hospitals requiring improvement failed to meet in 2008 did not include disinfection procedures.

Nonetheless, infections acquired at health-care facilities are among the top 10 leading causes of death in the country and drive up health-care costs by about $20 billion a year, according to the U.S. Department of Health and Human Services.

The U.S. Centers for Disease Control and Prevention has not confirmed any cases of HIV, hepatitis or any other virus directly linked to endoscopes, spokeswoman Christine Pearson said. But there have been outbreaks of bacterial infections transmitted through endoscopy, she said.

Lisa McGiffert of Consumers Union said similar incidents have been reported to the group's Stop Hospital Infections campaign.

“It's almost always a case of properly training the people who clean the equipment, which is a problem many health-care facilities have,” she said.

McGiffert also said inspections can be less than satisfactory in some cases.

“Our system of oversight of hospitals is pretty weak generally,” she said. “The inspections are too few and far between. They are mostly paper checks, and they don't typically look at outcomes like infection rates.”

But local hospitals say they follow strict disinfection protocols and are rigorously inspected.

Bon Secours St. Francis Health System, for instance, is inspected by DHEC and the Joint Commission, said Pat Fowler, vice president of surgical services. These visits include thorough examinations of the surgical areas to ensure sterilization equipment is working properly, she said.

St. Francis follows disinfection guidelines set by equipment manufacturers, as well as safety measures set by the Association of Operating Room Nurses and the Joint Commission, she said.

Scopes and tubing are disinfected through a multi-step process specifically designed for gastrointestinal procedures involving enzymatic cleaners, customized brushes, irrigation devices and a special ultra-sonic washer, she said. The equipment is inspected at points along the way and prior to use, and machinery is tested daily to ensure optimal performance.

“This is absolutely critical to ensure that every surgical instrument has gone through the correct and entire process,” she said. “St. Francis has not had any violations related to effectiveness of either the sterilization equipment or of any safety aspect with sterilized surgical instruments.”

Spartanburg Regional Healthcare System also follows professional standards for sterilizing equipment and instruments, said Tonie Edwards, clinical director of surgical services.

“We have internal processes in place and quality checks on all our sterilization process,” she said. “Patient safety is first and foremost. We don't take shortcuts.”

Edwards added that the hospital has never been cited for violating sterilization standards.

Greenville Hospital System University Medical Center also adheres to national practice standards, said Connie Steed, director of infection prevention and control.

Routine environmental rounds ensure machinery works well and proper procedure is reviewed with staff, she said. In addition, the staff undergoes annual competency checks.

Inspectors typically review sterilization and disinfection techniques, she said, adding that GHS has never had a disinfection violation, either.

Like McGiffert, Steed said training is key for patient safety, especially among new employees. Lapses can occur, she said, but they are typically the result of a “knowledge deficit or someone not following directions.”

McGiffert advises that patients discuss disinfection processes with their health care providers.

“Sometimes just asking questions helps get the provider thinking about what they're doing,” she said. “And hopefully they will respond with better infection control.”

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TOPICS: veterans, veterans' benefits, VA, Department of Veterans' Affairs, contaminated equipment, endoscopic, hepatitis B, hepatitis C, HIV