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A few observations from the article from a surgeon’s perspective . First of all, I agree with the article that sterilizing modern equipment is more difficult. Back when you just had steel equipment, you could just throw them in an autoclave and be sure that they were sterile (with the exception of prion diseases). As the article mentions, a lot of equipment can’t take that kind of treatment and or has areas that are had to access such as long channels.

In additions, not all surgeries are created equal with respect to infection risk. Joint surgeries are some of the highest risk for infection. In fact, when doing open joint surgery, orthopedic surgeons will wear what looks like a space suit with helmet and air supply and work under a giant air suction device to keep the would from being contaminated. Add to that, that they were putting in foreign materials in the form of screws, and you have a recipe for disaster if there is the tiniest bit of contamination. As I have told my patients and medical students, a surgical infection is a life altering event. There is a good chance that you will never be the same after experiencing it.

I think this type of thing will be a bigger issue as we move forward. Surgical equipment is getting more intricate and more expensive. Everybody is pushing to cut costs. Having less equipment for a hospital is less capital costs, but more times that it needs to be properly cleaned, and every time you clean is an opportunity to screw up.

I think the ultimate answer might be taking the responsibility of sterilizing complex surgical equipment from the hospital to the manufacturer. Basically, the hospital would use the equipment once and send it back for reprocessing back to the manufacturer. For a lot of these surgeries, the manufacturer representatives are there at the hospital for surgeries requiring single use stuff likes screws, rods, artificial joints, etc so this would just add to the stuff they are bringing to the hospital anyway. It would be much easier for the FDA is o monitor and regulate a few reprocessing centers instead of every hospital. Simple equipment that you can just throw in an autoclave, can still be done by the hospital. Doing this would also force the manufacturers to think more about ease of cleaning since they would be the ones responsible directly for it.

Just my 2 cents.




I was an SPD tech and Surgical Tech for a while and while I no longer have skin in the game it's still something that concerns me.

In our hospital anything that came from a Rep, sterilized or not, HAD to be reprocessed as of it were used because there is no way to verify conditions between transport; humidity, height from floor/ceiling, biological incubation and results. On top of that sometimes Reps would only have a single tray but the doc would schedule 4 back to back caeses needing that set. Who gets the blame when it's not ready in time? Not anesthesia for putting the pt under too soon, not the doc for their inability to contact spd prior to scheduling cases, not the nurse for failure to check with the scrub, no it's the SPD staff.

Things like yankhauer and Poole suctions are impossible to clean; many packs come with disposable ones now. Hell, the vast majority of surgical equipment is disposable but hospitals are in the making money business and reuse is much cheaper. Many clinics in our hospital were unaware of how to reprocess their items and would turn in soiled items that sat all weekend covered in blood without any enzymatic cleaner; not to mention half their items were single use but are being treated as multi-use.

Man, I'm glad I moved to being an assist and even happier I left the surgical field in general.


> As I have told my patients and medical students, a surgical infection is a life altering event. There is a good chance that you will never be the same after experiencing it.

What is it that makes such an infection is so impactful? Is there physical damage that persists, psychological trauma due to the experience, or some other factor?

Edit: Read the comments prior to reading the article.

> When Harrison awoke from that surgery, he imagined his nightmare was over. But in reality, it had just begun. Since then, what began as a simple operation has turned into a lengthy struggle that left him for months at a time dependent on hired nurses, unable to dress himself, take a shower, or work, and afraid for his life.


3 months in the ICU with an open abdomen (for example) is likely to cause all kinds of lifelong impact.


I’m definitely not qualified to answer this question. I speculate that a surgical infection is serious because the infection involves pathogens growing deep inside tissue that isn’t normally exposed to infection. Thus your immune system is ill equipped to fend it off.


If someone comes into hospital trusting the opinion of their doctors that this procedure is going to result in an improvement in their quality of life, and then instead of returning home better they have extended complications, it is just awful. I’m not sure how else to explain it - but consider if your mother/father/partner went to theatre for an elective joint replacement and then instead of being back at it in a couple of months, better than ever, was still in hospital undergoing rescue surgeries and strong antibiotics


In order to help you, a surgeon has to cut you and damage you. There's a huge amount of trust you have to place in the surgeon, the staff, the hospital, the equipment manufacturers, etc. Even if it all goes well, it can take weeks to years to fully recover from a major surgery. I know people who likely have PTSD from getting a good outcome. I cannot imagine if it went sideways. How would you trust that hospital, or any hospital?


Antibiotic resistant bacteria?


So what's the plan on prions? If an autoclave doesn't kill it it must be near immortal.


All instruments used on prion pts must be destroyed dead stop. They don't even get reprocessed/cleaned. Place in a bio bag and send them off.

A few years ago there was an issue with this in Germany


Nuke it with lye. Nothing survives lye, even nonliving germs like prions.


Problem with lye is it may cause pitting in metallic surfaces which is a problem because it gives bioburden something to grab hold to, thus harder to clean. Not only that but some sets contain a mix of metals and lye can cause those coatings to be removed.


Please excuse me if this is an uninformed question, but could this potentially be a use case for robotic/remote controlled surgery? It seems like getting a clean room set up where no humans outside of the patient are present could at least prevent operator in terms of contamination.

Of course, my fear is that the contamination comes more from everything that's not the patient or the surgeon as it pertains to the surgery -- nurses, cleaning staff, etc. Every actor and entity in that chain needs to ensure sterility, so the screws would have to be sealed until opened, the cleaning staff would have to use these kinds of space suits (or clean remotely) and likewise for the nurses. Unless or until this all becomes possible, the whole system is not going to be set up for sterility.


Surgeries don’t take place in clean rooms. The patients themselves are not clean. The contamination in these cases is coming from previous patients. So, unless you can make a self cleaning and self sterilizing robot, a human will be involved in turning instruments over for the next surgery.


>Joint surgeries are some of the highest risk for infection. In fact, when doing open joint surgery, orthopedic surgeons will wear what looks like a space suit with helmet and air supply and work under a giant air suction device to keep the would from being contaminated.

I can imagine how an open joint surgery has a high infection risk for the patient. But how does it also impose a risk for the surgeon?


All the interventions described seem to be designed for the purpose of keeping what the surgeon breaths out from getting into the wound.


The risk to the surgeon is the same in all other surgeries - ie. cutting yourself etc, although in Ortho theatres there can be good splashes which can throw fluid up over your head. You should always wear a face mask that has a visor or separate goggles in surgery to avoid splashed but the pulse lavage used in Ortho washouts has the potential to really spray fluids about.


Bad results could impact their income?


Joint surgeries are some of the highest risk for infection.

Can you expand on why that is? Do we know why joint surgeries are so problematic?


It is harder for infection fighting cells to get into the joint space compared to other tissues


lack of or reduced blood supply


You just made me happier that I declined the surgery for my separated shoulder.


Same here. I've been living with a partially torn labrum for a long time now and seems like outside the occasional flare up with pain that I can just treat with some ibuprofen, I am functionally fine. I am going to avoid going under the knife as much as I can.


You can probably fix it better with stem cells than surgery anyways. I’ve heard you can get treated out of pocket by Dr. Roddy McGee for a few grand.




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