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Sloppiness can increase risk during procedures

BY MATTHEW CHAYES.matthew.chayes@newsday.com

November 18, 2007

If a medical clinician's techniques are sloppy, almost any procedure - from a dental filling to a yearly colonoscopy to minor surgery by a podiatrist - can go from routine to risky, experts say.

"I can't think of any invasive procedures that can't lead to infection if done improperly," said Dr. Michael Bell, associate director for infection control at the federal Centers for Disease Control and Prevention in Atlanta.

Add to that assessment this variable: An increasing number of procedures, from nose jobs to skin biopsies, are being done not in the traditional hospital settings but in private medical offices and so-called surgi-centers, Bell said.

When medical procedures are moved out of hospitals, "there is a risk of not building in all the infection-control practices that are routinely used in the hospital setting," he said.

Bell's advice for the layman is to be up-front about concerns with those who are doing the treating and testing. Don't be afraid to ask questions, he said, and find out about techniques for sterilization and disinfection.

The potential for everyday procedures to transmit disease was highlighted last week with the state's revelation that anesthesiologist Harvey Finkelstein, in his Plainview clinic, contaminated medicine and endangered patients by using the same syringes to draw injections from more than one vial.

Experts say syringes never should be used more than once. When medical equipment is intended for reuse on multiple patients, as with endoscopes, dialysis machines and surgical equipment such as clamps and retractors, disease control officials "focus special attention for prevention," Bell said.

Endoscopes that are insufficiently disinfected, for example, can transmit disease, with one person's "colonic contents ... in another person," said Dr. Martin Blaser, chairman of medicine at NYU Medical Center and a past president of the Infectious Diseases Society of America.

Sterile techniques are especially important with routines such as dialysis, in which patients with kidney disease are hooked up to the same equipment to have their blood filtered.

Using proper techniques, clinicians can reduce to nearly zero the risks of cross-contamination, experts say.

Without proper techniques, invasive surgery - including procedures involving the lungs, kidneys or intestines - can "carry a higher level of risk," said Susan Russell, a nurse at the Decker School of Nursing at Binghamton University.

In everything clinicians do, experts stress the need to follow the lesson first taught in 1847 by Ignaz Semmelweis, a Viennese obstetrician who pleaded with colleagues not to deliver babies after conducting autopsies without washing their own hands.

Hand-washing has gained renewed publicity as an age-old prevention tool against infection by the MRSA superbug.

Said Russell: "Good hand hygiene is the most basic and best line of defense in the prevention of transmission of organisms from patient to patient or health care worker, and from health care worker to patient or other health care workers."