as excessive component breakage and
premature equipment failures (which can
affect patient care and be a significant
financial burden).”
It’s an issue not widely reported in the
medical and scientific literature.
“A review of publications about this
topic discovered a good job of addressing
how to clean and/or disinfect surfaces and
equipment, such as hard surfaces, bed rails,
floors, etc., as well as what class of agents
to clean them with and the importance
of doing this,” says Barbara Strain, MA,
CVAHP, SM(ASCP), founding member
and past president of the Association of
Healthcare Value Analysis Professionals
(AHVAP) and principal, of Barbara Strain
Consulting LLC. “The same publications
include discussion of the instructions for
use (IFUs), prevention of bacterial, viral and
fungal transmissions, roles of the EPA and
CDC, but most do not caution end users
of the potential effects that may alter the
function of the equipment/technology or
deface key labeling and/or instructions
important for use.”
Strain continues, “End users are very
good problem-solvers and report issues to
biomed, aka clinical engineering, supply
chain, infection prevention, etc., when
surface degradation or equipment malfunctions
occur. The standard resolution
is to immediately call for replacement
equipment or suggest a change to the
cleaning/disinfection agent. The bigger
question is to determine what to attribute
the issues to; without an appropriate problem-solving
session with subject matter
experts (SMEs) to identify root causes as
quickly as possible, the immediate solutions
may mask the issue or in the worst-case
scenario acerbate the issue.”
She adds, “The best education is to participate
in the selection of the equipment
or surfaces that are going to need to be
cleaned and/or disinfected. Participation
takes on many forms, for example, primary
end user groups can be represented by
department SMEs, senior leaders can
appoint an oversight group and mutually
agree on who should be actively involved.
In addition to the groups mentioned above
nursing, education services, environmental
services, equipment distribution and value
analysis should be included. Evaluation and
testing of equipment- and surface-related
goods should be internally reviewed
to assess compatibility with the results
shared with the manufacturer and any
changes mutually agreed upon. For ease
of compliance, a chart with equipment,
products and surface-related goods, along
with the tested and approved cleaning and/
or disinfectant products, should be readily
available. Access to newsletters, emails,
reports communicated to staff should be
available electronically for reference 24
hours a day.”
While they represent some of the most
significant challenges in the healthcare
environment, surfaces are not the only
objects susceptible to damage.
One biomedical expert who has
witnessed first-hand the impact of the
compatibility issue is Richard Fechter, a
principal developmental engineer at UCSF
Medical Center and UCSF Benioff Children’s
Hospital, who helps manage nearly
40,000 pieces of medical equipment. As
the primary investigator for medical device
incidents, he has seen numerous alarming
examples of equipment and device failures
that jeopardize patient safety.
“For me, the whole issue began in 2004
with an incident involving a syringe pump,”
recalls Fechter, who is also a member of
the FDA Medsun Medical Product Safety
Network and the American College of
Clinical Engineering (ACCE). His reports
have resulted in numerous recalls and
medical device corrections including critical
life-support equipment. “The healthcare
facility had recently changed its cleaning
products. Prior to 2004, almost everyone
used isopropyl alcohol, but our infection
control team decided that doesn’t kill all
the germs that we want to eliminate so
they wanted to try something new – a
quat. So, they rolled that out and probably
within a week we had a situation where the
syringe clamp on the syringe pump broke
off entirely. This machine was pushing
morphine, and because the syringe size
was wrong, the pump thought it had to
push twice as far to get the same amount
of medication out, so it was double the
dose. The patient was severely over sedated
but luckily it was caught in time to avoid
serious harm.”
Fechter continues, “We started examining
the other pumps in our fleet and
found that by that time pretty much all of
them had been destroyed. They were old
and we needed to buy new ones anyway,
but that is not the way to do it. I blame
the disinfectant as much as the handling
of the pumps.”
In his work for UCSF’s Surgical Innovations
Program, Fechter has studied
and developed a wide variety of medical
equipment, devices, test equipment and
both electronic and mechanical fabrication
and prototyping. Following that incident
with the syringe pump, and as a natural
extension of his professional curiosity,
he began to conduct some of his own
compatibility testing.
“It was most likely some of the first
compatibility testing ever done,” Fechter
says. “My test method was crude; I soaked
pieces of pump housing in different
cleaning chemical formulations and then
24 august 2020 • www.healthcarehygienemagazine.com