Better Clean Than Sorry

 After reading an article on the in-creasing problem of contaminated, dirty, and broken hospital equipment, I felt compelled to comment on this topic from a clinical engineering perspective. The article, titled “A Clean Sweep” and published in the May 2005 issue of Materials Management in Healthcare, highlighted how poor hygiene and unclean nonelectrical patient-care equipment like wheelchairs, IV poles, and stretchers can be linked to the growing problem of hospital-contracted infections. As health care-technology professionals, we have a role to play in preventing these deadly infections.

According to the New York-based Committee to Reduce Infection Death (RID), more than 2 million patients (that’s 1 in 20) contract hospital infections annually, and approximately 103,000 result in death. In fact, hospital infections are the fourth leading cause of death in the United States behind heart disease, cancer, and stroke, according to the Centers for Disease Control and Prevention. That’s as many deaths as recorded each year from AIDS, breast cancer, and automobile accidents combined. It’s also estimated that these often-preventable infections cost the nation $28–$30 billion annually.

Now, I know what you’re thinking: What do cleaning IV poles, stretchers, and wheelchairs have to do with us in the highly technical clinical engineering field? But considering the facts that when equipment is contaminated, it allows bacteria to be transmitted from one patient to another, and when hair or other debris get clogged in the casters of IV poles, a patient fall may result, we must begin to re-examine our processes to validate that we are doing all the right things to ensure that the patients we serve are safe.

We have a responsibility to be proactive in our approach to patient safety, especially when it comes to the equipment we service. In fact, the first tenet of the American College of Clinical Engineering Code of Ethics calls upon clinical engineers “to strive to prevent a person from being placed at risk of injury due to dangerous or defective devices or procedures.” Are we doing our part in the clinical engineering profession to improve the health care delivery system and to ensure that the equipment we service does not contribute to the growing problem of hospital infections?

When inspecting or repairing a particular medical device with a noticeable dry substance such as contrast media on the chassis, do you pull out a surface disinfectant and wipe it clean, or do you don gloves, ignore it, go about your task, and place it back in service? When inspecting mobile-cart and roll-stand equipment (like infusion pumps, laparoscopic carts, electrosurgical units, EKG machines, portable monitors, and ultrasound units, just to name a few), do you thoroughly check the casters for easy rotation and verify that they are free of debris, or do you simply base the caster functionality on your own strength to move the cart or pole? If these questions seem preposterous, I hope it’s because these tasks have always been part of your normal inspection procedure or because your hospital has an organization and communication structure that addresses the appropriate department to clean or repair these problems.

Obviously, we can’t oversee all the equipment we service for cleanliness and potential hazards that take place after it departs the clinical engineering shop or undergoes a routine inspection, but that is why it’s critically important for our clinician customers to thoroughly understand who they must contact when problems of this nature occur. Unfortunately, this is not the case for most hospitals. That’s why we have a responsibility to help tighten those communication gaps with our customers.

As health care-technology professionals, we set the bar high when it comes to the valuable service we provide for our customers. It’s also imperative that we apply these same high quality standards to the safety of our hospital’s patients. We must not succumb to the notion that hospital infections are not our problem. We all have a responsibility to serve each day as risk managers, to learn about the problems that impact the environment of care, and to use our available resources to ensure a patient-safe health care delivery system.

Ronald D. Snodgrass, CBET, is manager of clinical engineering at EMH Regional Medical Center, Elyria, Ohio.

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