The ramifications of failure are significant, according to Carr.
“When mattress covers fail, body fluids get into the mattress,
which is evident when we cut it open. Flooring is another common
failure, results in using duct tape and other stop-gap measures
that are unsightly and difficult to clean.”
The challenge is that the dangers of these failures aren’t
necessarily on the radar of busy clinicians who are preoccupied
with their patient-care responsibilities, and if the problems persist
without being addressed properly, they become expensive for
the healthcare institution to correct.
“I think clinicians are generally not aware of surface material
compatibility issuesCarr adds. “We also must contend with equipment
cleaning issues and variation around that as well. Adding
various surface cleaning nuances seems unrealistic. We shouldn’t
rely on clinicians to become familiar with the variations on how
to clean different surfaces, we should fix the surfaces.”
Experts agree that materials matter—designing and sourcing
devices made from disinfectant-compatible polymers reduces HAIs,
lowers the cost of ownership for healthcare providers and, most
importantly, improves the patient experience.
Minimizing surface damage is important in the healthcare
setting because damaged equipment can hide pathogens, be
very costly to replace and affect the overall image of a hospital.
The pathogen threat is continuing to evolve, and disinfectants
must stand up to the toughest pathogens. The challenge is that
more powerful disinfectants are also typically associated with poor
surface compatibility, because the very ingredients that break down
pathogens can break down other things as well. This can put the
healthcare professional in a difficult spot of making trade-offs
between efficacy or compatibility. Replacing damaged equipment
adds unnecessary costs to facilities when most are already financially
constrained. Surface damage like discoloration, cracks, residue,
and stickiness, can negatively affect patient perception of the
facility. Anecdotally, facility staff often have makeshift “solutions”
for handling equipment that has cracked or became discolored
due to disinfectant use. This highlights the fact that healthcare
professionals are aware of these problems but sometimes feel
resigned or powerless about finding solutions.
The compatibility issue was addressed in ECRI Institute’s report,
Top 10 Health Technology Hazards for 2017, which described
device failures caused by cleaning products and practices: “The
use of cleaning agents or cleaning practices that are incompatible
with the materials used in a medical device’s construction, or
that are otherwise inappropriate for the device’s design, can
cause the device to malfunction or to fail prematurely, possibly
affecting patient care.”
Specifically, the ECRI Institute report noted:
• Repeated use of incompatible cleaning agents can damage
equipment surfaces and degrade plastics, often resulting in device
breakage—possibly with no visible warning signs.
• The use of improper cleaning practices can damage seals,
degrade lubricants, and cause fluid intrusion. This can result in
damage to electronics, power supplies, and motors.
The report adds, “Because there is no single cleaner or
cleaning process that will work with all devices, hospitals must
stock and use multiple cleaning products and familiarize staff
with device-specific cleaning methods—tasks that pose a
significant burden. Nevertheless, failure to do so can lead to
ineffective cleaning (a potentially deadly circumstance), as well
Continued from Page 20
external ventricular drain devices. These devices attach to a
catheter inserted into the ventricle of the brain and drain excess
CSF to limit intracranial pressure. There was a stopcock on the
device that was constantly breaking off, potentially allowing
pathogens to enter the system and cause a brain infection.
The broken stopcocks also caused the CSF to drain too rapidly
and disabled the monitoring of the intracranial pressure. We
filed a number of FDA Medwatch reports and worked with the
manufacturer to solve the problem. Eventually the manufacturer
came out with a much stronger stopcock that eliminated the
breakage problem we were seeing. Not only did this solve the
problem for our facility, but for everyone who uses that product.
Another example: Years ago, we investigated an overdose
involving a syringe pump. At some point our infection
prevention department had introduced a new disinfectant
cleaner that was more effective at killing TB and other nasty
hospital germs. The new cleaner was not compatible with the
plastic material used on the syringe pump and caused rapid
disintegration of the pump parts. The pump involved in the
incident was missing a part on the syringe saddle that caused
the pump to incorrectly sense the syringe size. The pump now
sensed a 30ml syringe when a 60ml syringe was actually installed.
This caused the pump to deliver two times the intended dose of
morphine. Luckily there was no permanent patient harm, but
it could have easily been fatal. Following that event, we did a
series of tests and eventually found a disinfectant product that
killed the required germs and at the same time was compatible
with the pump materials. While the situation has improved over
the years, this is still a constant problem.
We also frequently find cases of poor human factors design
with equipment that results in “user error.” While it’s easy for
manufacturers to blame the users, the design of hardware and
software often makes certain types of mistakes much more likely.
In our response to the COVID-19 pandemic, our engineers
used 3-D printers and laser cutters to make face shields and parts
for our CAPR helmets that were desperately needed. We also
assisted in setting up new “surge” units for COVID-19 patients
and evaluated various methods of decontaminating N95 masks.
HHM How can clinicians/risk managers/value analysis
professionals and other stakeholders improve their communication
and collaboration with biomedical engineers?
RF: In most cases, I think they just have to ask. Like everyone
else in the hospital, the engineers are very busy but willing to
help, especially when it comes to improving patient safety.
Problem solving is our business.
HHM What can everyone do to ensure the best
clinical/operational/fiscal outcomes relating to devices/
equipment?
RF: Do your homework before purchasing equipment. There
are many resources such as the FDA and ECRI that can help you
find out if a particular model or device has a bad track record.
Report problems! We can’t solve a problem if we don’t know
about it. While we may not be able to solve all problems, we
can certainly help avoid common ones. The squeaky wheel
gets the oil.
22 august 2020 • www.healthcarehygienemagazine.com