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What Knee Patients Need to Know About Single-Use Instrument Reprocessing
June 17, 2003
By Adrian Brune for Knee1
Active Americans with aging joints preparing for orthopedic surgery need to make themselves aware of another procedure taking place in hospitals today: the reuse of surgical instruments designed to be used only once.
A recent survey conducted by the Center for Patient Advocacy found that most patients have no idea that hospitals are using reprocessed, single-use instruments, such as surgical blades, catheters and forceps, on multiple patients and that most health care professionals have grave concerns about their reuse for patients’ safety. Reusing these instruments poses a health risk to patients, including the potential spread of hepatitis and HIV, according to three out of four surgeons interviewed in the survey.
“The fact that surgeons and nurses are overwhelmingly concerned that the reuse of single-use devices poses a threat to the risk of infection and the spread of disease should raise red flags with the public,” said Dr. Neil Kahanovitz, the president and founder of the Center for Patient Advocacy.
“How can we expect patients to feel safe with these reused devices?”
The survey found that 82 percent of nurses and 71 percent of surgeons would be uncomfortable if a reprocessed blade or catheter were used on them, yet 65 percent of patients are unaware that these surgical devices may have previously been used – often multiple times – in other patients.
Approximately 25 percent of US hospitals use reprocessed single-use only devices. Single use only devices are devices that are meant to be used only once on a body part, and then permanently discarded because they have come in contact with bodily fluid. Single use devices are used in such surgeries as oral surgeries, orthopedic surgeries and cardiac surgeries.
The practice of reprocessing devices that are intended for single-use (SUDs) began in hospitals in the late l970s, according to the Food and Drug Administration and reuse proponents argue that it is safe and saves millions of dollars. Instead of buying new devices from manufacturers, hospitals send the used ones to companies that sterilize or disinfect instruments through pressurization, filtering or sharpening techniques.
“The explanation for this resistance by doctors and hospitals against expert opinion and direction from higher authorities is based on two important factors,” wrote Keith Woollard, a Cardiologist at St. John of God Medical Clinic in Murdoch, Washington in a sports medicine article for eMJA, the Medical Journal of Australia. “Firstly, there are apparently no reported cases in the medical literature of transmission of infection between patients as a result of the reuse of single-use medical devices; and, secondly, in the absence of any demonstrated adverse effects on patients, hospitals and doctors are not prepared to divert funds from other areas of medical care.”
Some hospitals say reprocessed single-use medical devices are perfectly safe and cut down on expense and waste. Others refuse to use them because of concerns over patient safety. Knee1 has developed a consent form for use by patients who do not wish reprocessed single-use medical devices to be used in their procedure. Seventy percent of patients in the Center for Patient Advocacy's survey were unaware they had that right.
“Patients should exercise their right to say no,” said Kahanovitz.
* Images courtesy of Smith & Nephew Endoscopy (a sponsor of this site).
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