Making Hepatitis History Part 2: Sterilization logs can help uncover medical negligence
One of my first investigative stories as a reporter started with a call from a doctor who was worried about the sterilization practices at his hospital.
I started calling people at the hospital to try to answer some basic questions about what they were doing to make sure that surgical equipment was clean between procedures. "Why don't I just come down and take a look at your process?" I suggested.
And that's how I saw the sterilization logs.
Every time surgical equipment is sterilized, there are simple tests performed to see if any bacteria survived the cleaning. Medical center staff keeps logs detailing the tests.
In public hospitals, these are public records. In a private hospital like the one I visited (and the surgery center being nailed for the biggest Hepatitis C outbreak in US history), you need to ask to see them. Or you need to find someone on the inside to show you these records, like a nurse who didn't like being pressured to cut corners or a doctor who had a patient who ended up with an infection and went looking for someone to blame. Or you need to track them down in lawsuit filings, criminal filings or bankruptcy records.
What do these records look like? Here's an example of one from the County of San Diego.
What are you looking for?
1. Did the medical team use the right type of sterilization? The CDC has some specific guidelines for what should be done for different types of surgical equipment and different types of bacteria and viruses. Generally, it says, "Of all the methods available for sterilization, moist heat in the form of saturated steam under pressure is the most widely used and the most dependable."
2. Did they use the sterilization equipment in the right way? "The basic principle of steam sterilization, as accomplished in an autoclave, is to expose each item to direct steam contact at the required temperature and pressure for the specified time," says the CDC. "Thus, there are four parameters of steam sterilization: steam, pressure, temperature, and time." Medical staff can get any one of these four wrong.
3, Did bacteria survive the sterilization process? Northeastern University has a good description of their lab processes that will give you an idea of how things are supposed to work. If bacteria are starting to grow 48 hours after the sterilization, there's a problem.
4. Did they ignore repeated problems with the same sterilizer? Anyone can make a mistake, but if you see multiple dates that show spores surviving sterilization following a surgery, you have a story.
5. What did they do when they had a complaint? In the case I wrote about, they tried to shut everyone up. A surgeon had a patient who developed an infection. The infection was traced back to dirty surgical equipment. Instead of talking about it with everyone on the staff and trying to solve the problem, they tried to shut the surgeon up and keep everything quiet. Until I called.
As is often the case, the cover-up can be a better story than the crime.
Related posts:
Making Hepatitis History Part 1: Michael Jackson's deadly drug strikes again
Making Hepatitis History Part 3: Bankruptcy court holds dirty secrets little and large
Making Hepatitis History Part 4: Time stamps can separate medical fact from fiction
Making Hepatitis History Part 5: Purchasing records reveal dangerous penny pinching