In October 1995, six consecutive cases of malaria appeared in Taipei Veterans General Hospital, shocking health units. The investigation found that the source of the malaria was a patient who had returned from Nigeria, Africa, with fever and jaundice, and underwent a computerized tomography examination, during which blood containing Plasmodium vivax flowed back into the contrast syringe.
These syringes and catheters are supposed to be disposable supplies, one set for each person, but because each set costs about $300 and is not covered by health insurance, the unit supervisor instructed that the syringes and catheters should be used continuously, and replaced only once in the morning and once in the afternoon. This cheap practice has resulted in six subsequent patients receiving contrast dye injections being infected with malaria, and four of them have died.
After years of litigation, the case was finally decided in 2006, with three physicians sentenced to one year in prison and three years' probation. Another physician was acquitted in the first trial, but still committed suicide by injecting potassium chloride in 1998.
Have we learned a lesson from paying the price of so many lives? Apparently not.
Can discarded medical materials be reused?
There are many hospitals that send disposable medical materials to be sterilized and then reused. All of the disposable medical materials are clearly labeled "for single use only" on the packaging, but based on cost considerations, hospitals are ignoring this and will use them repeatedly until they are destroyed. The most common are laparoscopic or thoracoscopic surgical instruments, which are usually more complex in construction, and may have joints, grooves, or cavities, and are very prone to residual blood or tissue debris, and in the case where they cannot be disassembled, it is absolutely impossible to clean and disinfect them thoroughly, and therefore reuse is not recommended at the time of design and manufacture. However, these instruments are expensive, and the instruments and consumables used in a surgery are often worth thousands or tens of thousands of dollars, so they are almost always reused for sterilization.
Most metal instruments can be sterilized by autoclaving, while instruments with plastic parts are more likely to be sterilized by ethylene oxide gas.
A team of researchers tested single-use medical devices (IV needles, tracheal cannulae) and found that after 10 cycles of ethylene oxide gas sterilization, the amount of microorganisms remaining on the devices was significantly reduced, but there were still up to 1,000 CFUs (colony-forming units), and if you look at them with an electron microscope, you can see a lot of damage or scratches on the surfaces. The surface of the product is damaged or scratched.
Researchers at the University of Tübingen, Germany, conducted a series of tests directly on laparoscopic instruments and found that even after standard cleaning and disinfection procedures, contaminants could still be found on the surface or inside through the microscope and the microorganisms could not be completely eliminated. On the other hand, the re-sterilization process was also damaging, with one-third of the instruments tested missing parts and more than half failing to function properly. In other words, re-sterilizing and re-using disposable medical devices that are designed for single-use may not only cause infections, but may also cause the devices to malfunction, resulting in unforeseen hazards during surgery.
Don't be so naive as to think that you won't encounter re-sterilized medical materials as long as you don't undergo laparoscopic surgery. Because in addition to expensive laparoscopic instruments, many hospitals reuse even less expensive medical materials.
Most electrosurgical pens, which are used in almost all surgeries, are disposable, but are often sterilized over and over again until they become unusable. The skin stapler, which is very similar to a stapler, contains a row of about 30 staples, and if they are not used up, they are usually sterilized and reused in the next knife.
In addition, some hospitals, in order to save money, even spend a lot of money on threads, which are essential for surgery. They will discard pre-cut and sterilized threads and use a whole bundle of threads, which is cut by the nurse scrubbers for the surgeon, and then send the whole bundle to be sterilized, so that the whole bundle of threads can be used by many patients. This is a very dangerous practice because it is impossible to clean a thread that is contaminated with blood or body fluids.
Also, in some hospitals, even leftover gauze is sent to be re-sterilized and re-distributed. If you see a healthcare worker using gauze that is not freshly unpacked when you visit the doctor, it is most likely in this category.
Disclosure and informed consent should be mandatory
In poorer countries, where resources are scarce, the reuse of disposable medical materials is a necessity, and some scholars have argued that restrictions should be relaxed. They argue that the use of ultrasound, pressurized water flow, and enzymatic cleansers to clean the instruments, and then sterilization by ethylene oxide gas, makes them safe for reuse.
Due to the cost of medical care, the issue of whether or not to reuse disposable medical devices will continue to be debated, but informed consent is absolutely essential when reusing disposable medical devices. Medical institutions are required to inform patients of the possible risks beforehand so that they can make their own choices.
Disclosure of information about the use of disposable medical devices should be mandatory, as it is the patient's right to choose which device to use.
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