Healthcare Hygiene magazine August 2020 | Page 24

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