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Colon and rectal surgeon Sanjiv Patankar allegedly washed and reused catheters that are inserted into patients' rectum during medical procedures. The instruments, which are used to examine patients with fecal incontinence, constipation, and other possible disorders, are supposed to be thrown away after a single use.
Patankar, who practiced in East Brunswick, [New Jersey] allegedly instructed medical assistants to wash the instruments in soapy water after use, soak them in bleach solutions, and then rinse before air-drying them. The doctor also reportedly ordered to continue using a catheter that has started to break down due to overbleaching.
In a hearing conducted Dec. 19, the state said that documented evidence appears to show that between Jan. 1 and Nov. 30, Patankar's office performed 82 procedures but only five catheters were used over that period.
(Score: 3, Interesting) by JoeMerchant on Thursday March 01 2018, @01:56PM (17 children)
Reuse of single use medical devices is very common practice.
The problem with it is: you've got M.D.s who know f-all about device safety and even sterilization making judgement calls about how, and how long they can reuse a device.
Sterilize a device too aggressively and you degrade its function (like the overbleached catheters mentioned in the summary), don't do it aggressively enough and you get cross-contamination.
All in all, if I'm going to be cross-contaminated, I'd rather it happen in the lower bowel instead of the bloodstream or sub-cutaneous tissue. Of course, if the cross-contamination is coming from someone with bowel problems, that's less than ideal, but Sanjiv's homebrew bleach solution probably knocked back the levels of live cultures to something more or less trivial for an existing bowel flora to overwhelm. But, I'd bet his methods were far from the level of "sterility" required for official labeling of medical devices as such.
I attribute some of this situation to the "M.D. god complex" that we push them into. Their time is so precious, their judgement so valuable, they literally do get god complexes that make them blind to their limitations.
🌻🌻 [google.com]
(Score: 2) by Lester on Thursday March 01 2018, @03:34PM (8 children)
They only must have been designed to be sterilized many times. Many medical devices, like scalpels, scissors etc, are regularly sterilized and reused many times.
For years syringes and needles were reusable, they were sterilized and reused. That changed when HIV appeared. Until then, except cotton, bandage etc, most medical devices were reusable. Disposable devices have several advantages, you don't waste time sterilizing, you don't need a big department of sterilization so you reduce costs, and you reduce cross-contamination risk to 0%. On the other hand, you have to buy many times and there is more overspend. So, disposable elements much be cheap to balance the cost of sterilizing it.
Nevertheless, there is a trend, each time disposable elements a more expensive. I suppose that it is a combination of consumerism society, convenience and health staff laziness.
(Score: 3, Informative) by JoeMerchant on Thursday March 01 2018, @04:14PM (5 children)
Personally, if I'm having a catheter inserted in my rectum, I'd rather it not be constructed of the same types of reusable medical materials as are used to make scalpels, needles and (reusable glass) syringes.
The soft, flexible medical materials do not tend to hold up well to repeat sterilizations, whether by heat, EtO, or soapy water and bleach (which is more of a cleaning solution than a certifiable sterilization process.)
The disposable/reusable issue in the med device industry is a weird thing that kind of cycles like fashion. LOW COST LOW COST LOW COST they chant, so you give them a low cost disposable, 1/10th the price of a sterilizable reusable one, but that's not good enough, they should be able to sterilize and reuse the device 100 times, so then they want the durable version. There's a practical point at which the cost of sterilization (staff time, equipment maintenance, etc.) exceeds the cost of the device (and this point varies widely around the world due to labor costs), but... there's also a whole other layer of absurdity piled on when a relatively simple surgery bills out at $15K, so why wouldn't you use a $500 disposable device during that surgery if it increases the chances of a good outcome?
🌻🌻 [google.com]
(Score: 2) by frojack on Thursday March 01 2018, @06:41PM (4 children)
I'm amazed you have such faith in the factory packaged plastic device ASSUMED to be sterile out of the package. I don't.
Its a numbers game. Of the millions made, probably only 10 percent are contaminated at the factory, and probably the patient's immune system is sufficient to handle 70 percent of those cases, and the anti-viral/biotics will (probably) handle most of the rest.
No, you are mistaken. I've always had this sig.
(Score: 0) by Anonymous Coward on Thursday March 01 2018, @07:45PM
There is a difference between bacteria found on a surface of an air exposed surface and bacteria out of someone's leaky ass. C. diff. is not that likely to live in one of these places.
https://en.wikipedia.org/wiki/Clostridium_difficile_infection [wikipedia.org]
(Score: 2) by JoeMerchant on Thursday March 01 2018, @08:08PM (1 child)
Take a tour of a med-device sterilization facility sometime, then tell me what your 10% non-sterile estimate turns to. I'm sure there are some places where it would run higher, but the ones I've worked at in the U.S. probably run closer to 0.001% non-sterile at time of unpackaging, and those that are non-sterile are mostly sterile.
The latest trend in sterilization is fast-cycle EtO - we just decreased our cycle time to 12 hours. EtO is nasty, explosive stuff - if our EtO facility ignited, it would leave a big crater, and the "windows blown out" blast radius would be something like 500 meters. They put up with this little challenge because it's really really good at killing bacteria and viruses without degrading the finished products being sterilized. It's not your hospitals' typical autoclave.
🌻🌻 [google.com]
(Score: 0) by Anonymous Coward on Thursday March 01 2018, @10:39PM
what a cool looking simple molecule
(Score: -1, Flamebait) by Anonymous Coward on Thursday March 01 2018, @08:51PM
This, right here, is what makes frojack the conservative he is! Fear of disease, aversion to bad smells, invincible ignorance and a foundational lack of trust in his fellow human beings. I don't know how someone could live like that, at least not without a large hoard of single-user anal catheters that he had sterilized himself.
(Score: 2) by HiThere on Thursday March 01 2018, @07:38PM
But if you remember, before reuse the devices were supposed to not only be washed, but autoclaved. Boiling wasn't considered hot enough.
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 2) by requerdanos on Thursday March 01 2018, @10:03PM
I understand that it's a balance, and not only that, but a balance designed to reduce not only costs but injuries and deaths. But playing devil's advocate for a moment...
Isn't this time, and more, now spent manufacturing hundreds of thousands of medical devices to replace a single device that previously would have been used repeatedly throughout a long service life, and also spent managing and maintaining ever-larger landfills to contain an ever-larger percentage of waste now deemed "disposable" instead of "durable"?
You reduce costs by buying an item 5,000 times instead of once?
I submit that each iteration of each device would have been made more and more cheaply, anyway, regardless of whether it was intended for multiple or single use.
There remain a staggering number of vectors for cross-contamination (same person touches two devices, two devices touch same surface, etc.) even after you start printing "Use This Thing Only Once" on the packaging. For a case in point, consider the story you're commenting on.
(Score: 2) by requerdanos on Thursday March 01 2018, @05:00PM (7 children)
This is complicated by another problem somewhere. I don't know whether it's strange regulation, or merely manufacturers to blame, but last time I had surgery done, the site of the surgical procedure was marked with a sharpie marker covered in warning labels about how Federal Law Prohibits Re-Use and that the user must Discard After Use.
I pulled it out of the trash and used it to label burned CDs and DVDs until it ran out (years later).
Seems to have been a thing about how the manufacturer can't guarantee that it's sterile after the first use--I get that--but that statement applies to nearly everything in the hospital that's not disposable. We don't throw the hospital away and rebuild it between patients because that would be stupid. This is sort of like that.
Because of this non-sustainable disposables-mentality, there is not a culture of proper, safe sterilization being encouraged.
(Score: 2) by HiThere on Thursday March 01 2018, @07:44PM (6 children)
Partially yes, but also partially no. Bacteria are evolving to evade more and more of our sanitary procedures. Single use sharpies are a bit over the top, but using them only on one patient is quite a reasonable procedure. And we're approaching the point were the hospitals may not be single use, but the room furnishing are. This is usually excessive caution, but not always. Many iatrogenic diseases are spread by insufficient sanitary procedures, and some have been traced to bacteria that lived on the curtains of the room between patients.
Caution: I am not associated with any hospital, so I can't tell you what current procedures are. But some bacteria are evolving to become immune to the alcohol hand sanitizers, so expect an increase in the use of plastic gloves.
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 3, Interesting) by JoeMerchant on Thursday March 01 2018, @08:02PM (4 children)
It really does get down to the question of: you're charging $15,000 for this procedure, do you want to save $5 on a reusable sharpie when that puts a 0.1% chance of infection and bad outcome which might lead to $100K+ in malpractice settlement? Far better to charge $15,100 for the procedure and use the $5 disposable sharpie.
🌻🌻 [google.com]
(Score: 2) by requerdanos on Thursday March 01 2018, @08:15PM (3 children)
Well, they're more like $1.00 - $1.50 [bettymills.com] in lots of 50, manufacturer guaranteed sterile, bundled with a free sterile ruler and a pack of blank labels.
So maybe this is a bad example.
(Score: 2) by JoeMerchant on Thursday March 01 2018, @09:10PM (2 children)
did you find an itemized line item for it on your surgery bill? They have started doing something sensible like charging $100 for miscellaneous stuff which catches things like the sharpie, but if it's itemized, I doubt it's less than $5.
🌻🌻 [google.com]
(Score: 2) by requerdanos on Thursday March 01 2018, @09:27PM (1 child)
No, that's just what it would cost the hospital if they bought from the link above.
(Score: 2) by JoeMerchant on Thursday March 01 2018, @09:33PM
That's the purchase price, then there's the general accounting overhead, cost of storage, cost to ensure safe delivery to the patient, cost of damaged goods, etc. etc. etc. - those are the wonderful accounting methods that come up with a price of $10 for a Tylenol capsule delivered to you postoperatively.
🌻🌻 [google.com]
(Score: 0) by Anonymous Coward on Friday March 02 2018, @12:17AM
You sure about this? I didn't think alcohol was something bacteria could become immune to.
A google search only leads to a recent New Scientist news article on this, but nothing else of note, and the New Scientist article is paywalled, so I can't see what it says.