Report Argues Outbreaks Linked to Inadequately Cleaned Surgical Instruments

March 9, 2012 | Strategic Insights for Ambulatory Care


An investigative report by the Center for Public Integrity highlights the potential for infections from inappropriately cleaned, reprocessed, and sterilized surgical instruments. The report focuses on an outbreak at one hospital in which at least seven patients who had undergone joint surgery acquired serious infections over a two-week period. Although the report addresses hospital operating rooms, it also has relevance for ambulatory surgical settings. The outbreak caused the hospital to close its operating rooms and cancel some surgeries in order to trace the source of the infection, which was investigated by internal staff and the Centers for Disease Control and Prevention. The investigation found that two instruments used in these surgeries, the arthroscopic shaver and inflow/outflow cannula, contained human bone and tissue.

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