Question: I work in a community hospital in the outpatient department. A chiropodist is starting here and she sterilizes her own instruments in a benchtop sterilizer. We send all of our instruments off to the CSSD to conform to HTM2010. Are there any specific infection control issues I need to consider before she starts? I am most worried about the sterilizing, as she is putting patients and herself at risk. -- JS,
Answer: You are right to be concerned for your patients and for this doctor. While doctors are very well trained for their areas of expertise; however, they have little or no knowledge of the what, how or when concerning sterilization and the standards of practice that must be undertaken to prevent harm to patients and to themselves. I do not know if this is true of this doctor but it seems to be an across-the-board kind of thing. First, is this person certified and has the complete knowledge to safely reprocess items for reuse? Are the items supposed to be reused? What are the recommended sterilization parameters? Often, tabletops are not able to accommodate all sterilization cycles. Who is assuming liability if something goes wrong? What if a patient gets an infection or the device fails? What solutions are being used? Where are these items being cleaned and how are they being cleaned? I strongly recommend that you have a conversation with your new doctor. Explain your hospitals practices concerning sterilization (which should follow the recommended standards of practice). Explain also the need to have everything handled the same way with your concerns for liability notwithstanding. Explain that you are concerned for their safety and the safety or your staff and patients, as I am quite sure this doctor does not use EPA/UK approved solutions to reduce macro/micro bioburden and most likely is cleaning these devices in a nearby sink, not in a soiled utility area designed for such a practice. Offer a new and improved way for this doctor to handle the devices safely and assure him/her that your processing department will take the utmost care of the items used following the manufacturer's recommended instructions for use and or re-use if that applies here. Show this doctor your procedures for such devices or any device/instruments you handle for their safety and most importantly the safety of your patients. Most likely this doctor has had to handle things for himself/herself whereever they came from. Offer a better way by offering your hospitals finest expertise in sterilization/processing. Make this an offer of service that you require for everyone's benefit. Make sure they know how much you respect them and how much you desire to help them. This will likely be a new thing for this doctor but if handled diplomatically, it can be a good thing for everyone concerned. Thank you for asking your question and for your concern for your new doctor and patients. Your due diligence is applauded. Your patients thank you for being their voice!