HHM Compatibility Special Edition Feb/Mar 2020 HHM Compatibility Special Edition Feb:Mar 2020 | Page 14

Examples of damage caused by incompatibility between materials and cleaning/
disinfection chemicals. Images courtesy of Richard Fechter.
tops, so as a percentage of the manufacturing cost, that raw
material is nothing. Even if they pick a better-performing
plastic that is twice as expensive as what they are using, it
is insignificant in the total cost of that infusion pump. So, I
don’t think they have a lot of excuses.”
Desired cosmetic finishes and aesthetics are likely to
dictate manufacturers’ decision-making, Fechter adds. “In
addition to the look of a product, there may be mechanical
properties dictating function over form. Some of the final
materials used in the finished product hold up better than
others, so you must convince manufacturers to move away
from their favorite things like polycarbonate and ABS and
use more resistant and durable formulas and materials.
it is going to increase the cost of the product, yes, but
not significantly.”
“Another aspect of the problem is not just the materials,
but the design of the product itself,” Fechter emphasizes.
“If you have a flat, smooth surface and you wipe it with
disinfectant and it dries off, those flat smooth surfaces tend
to not suffer damage. Where you see the damage is in the
nooks, crannies, corners, around fasteners or any kinds of
seams where the liquid disinfectant seeps into the cracks
and crevices and stays wet a lot longer than it would on that
flat, smooth surface. From an overall cleaning standpoint,
and especially from an infection control perspective,
most devices are designed with far too many nooks and
crannies that invite body fluids and blood to get sucked
in and then contamination persists in these areas that are
nearly impossible to clean and disinfect properly. To be fair,
we have seen some improvement in recent years with the
introduction of more control panels manufactured from flat,
smooth glass that so much easier to clean. For example, in
the old days, ultrasound machines had a million knobs and
switches, and now we are seeing new machines out on the
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market that have simple glass touchscreens. From a cleaning
standpoint, these surfaces are wonderful because there
are fewer places for germs to hide, and even a pretty poor
disinfectant will address the microorganisms on it. From a
user standpoint, some clinicians still say they like the feel of
the old-fashioned knobs and buttons, but it is something
they’re going to have to get used to, and I don’t think it’s
that hard to use a glass touchscreen.”
Designing equipment so it is easier to clean is just part
of the issue; the benefits of improved device design can be
lost if no one actually cleans it. Healthcare facilities have
been struggling with ensuring accountability between
clinicians and environmental services when it comes to
which party is responsible for cleaning and disinfecting
patient-care equipment.
“It’s not consistent in most facilities,” Fechter acknowl-
edges. “In one unit you may have environmental services
personnel cleaning the equipment and then you go to
another area of the institution and you see clinical or biomed
professionals cleaning some of it, too. We see a lot of
problems stemming from improper cleaning, and we know
it can be a challenge to educate and train the many different
people who are cleaning and disinfecting the equipment.
“So, we have this device, and we know it must be cleaned,
but when it comes to manufacturers’ instructions for use
(IFUs), many of them can be suboptimal, confusing, or flat-out
wrong,” Fechter says. “Even if the IFUs are wrong, we are
mandated to follow them whether they are right or wrong.”
As an example, Fechter points to telemetry boxes. “These
are little wireless transmitters that have ECG leads attached
to pulse oximeters and they transmit data to a monitoring
system. Between patient use they are cleaned, but we are
seeing electrical contacts and patient cables in the batteries
are all turning green and fuzzy. These boxes are dropping
like flies because of improper cleaning. Patients are going
unmonitored because these boxes go offline or have failed
completely. There are so many of these in the hospital that
when one of them drops off the radar screen, someone
must track it down and find out what happened to it.
Hospitals experience equipment shortages and then have
no means to monitor patients. If something happens to a
patient because the telemetry box wasn’t working, it is a
huge liability issue.”
Fechter provides another example. “Glucometers must
be cleaned and disinfected because they get blood on them,
and the healthcare worker wipes them with bleach wipes,
which is the cleaner/disinfectant recommended by the
manufacturer, and it doesn’t destroy the plastic and that’s
good, but they sit in a cradle when not used and the issue
is that when you clean them and then drop them into the
cradle it corrodes those contacts, they stop charging, they
can’t transfer data and they go dead.
The glucometers may be working but when healthcare
workers drop them in the cradle they don’t charge. When
you watch how they are cleaned, you see that they will be
wiped and then dropped into the cradle immediately, while
they still may be damp, and that is the worst thing you can
do. The contacts become corroded and crusted, and you
must scrape them off. if you read the instructions for use
carefully, you are supposed to wipe them with the cleaner/
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