BFK Solutions LLC
Pacific Palisades, Calif.
& Safety Services
ccording to the U.S. Centers for Disease Control
& Prevention, in the U.S., approximately one out
of every 20 hospitalized patients will contract a
nosocomial infection, an infection associated with
the health- care environment. The direct hospital costs were
estimated between $35.7 to $45 billion affecting 1,735,000
patients, with 99,000 deaths. This does not include indirect
and intangible costs such as lost wages, diminished worker
productivity, short term and long term morbidity, mortality,
income lost by family members, forgone leisure time, time
spent by family/friends for hospital visits, travel costs, home
care, psychological costs (i.e., anxiety, grief, disability, job loss),
pain and suffering, and change in social functioning and daily
Hospitals should prevent or cure disease—not become sources
of disease. Given the magnitude of nosocomial infections, training workers, particularly those involved with medical devices, is
critical. Reusable medical devices must be thoroughly cleaned,
sanitized, disinfected, and, in some cases, properly reassembled.
Avoiding inadequate sanitization or disinfection is a global issue.
Contamination may be biologic or non-biologic. Contaminants
may be active or dead. Disinfection and sterilization are not
enough. Cleaning is essential to assure optimal performance of the
device and to avoid environments that can promote the growth of
organisms. Effective training encompasses the correct handling and
management of medical devices to assure proper operation and
reduce exposure hazards to healthcare workers and patients.
How not to train
“Canned” training programs are not sufficient. In-print and
online programs may provide the basics and allow for a quick
review. Yet, they often do not reflect the literacy, level of education, or language of those being trained. Professional educators
emphasize that better learning occurs when students are engaged;
tapping a key on a keyboard or viewing a video does not provide
a meaningful learning experience. A canned program does not
encompass the reality of a specific work environment. Without
compelling evidence that the information has to be retained and
acted on, actual practices and behavior may not change.
What makes a good training course?
A good course is comprehensive, unambiguous, well document-
ed, integrated, encompassing, and holistic. It “sticks.” Workers
learn, understand, and apply the material being presented.
They incorporate the information into their daily activities.
Therefore, an effective training course has to be appropriately
designed to reflect the way the students learn.
The right education program involves considering potential hazards from a number of perspectives. For example, in
the clinical setting we have to minimize hazards to workers,
patients, and the environment.
A risk hazard approach
Device manufacturers designing effective training courses
benefit by going into the field to see how their device is used.
This exercise starts at the design stage and moves forward.
It is evident that small refinements can make the difference
between an easily operated and assembled device and one that
is prone to malfunction and contamination. For all devices, it
is enlightening to visit the actual site, to see how devices are
used, cleaned, sanitized, and disinfected.
Employee exposure can include inhalation and contact
exposure. This includes evaluating the impact, individually and collectively, of all cleaning and disinfecting agents.
Alternative chemicals that may appear to pollute the air or
water less may have adverse impacts on the safety and health
of workers or patients, or vice versa.
Evaluating hazards to the patient is even more complex. A
chemical may have benign respiratory effects yet may be harmful to the patient. There may be other routes of exposure, particularly where a device comes in contact with blood or tissue.
Leachable residue and outgassing must be considered. A device
that is not cleaned and sanitized correctly may not function
properly. Cleaning directions have to be clear, concise, practical,
and achievable. For example, immediate disassembly of a device
may be highly desirable because the longer a soil is in contact
with a substrate, the more adherent the soil becomes. In clinical
environments, patient issues may take priority over immediate
disassembly and cleaning of the device. This is where the site
visit can be particularly valuable. By evaluating work flow, it
is often possible to design an optimal approach that considers
immediate patient needs and product safety.
The OSHA interpretation of adequate training is one that
might be emulated for a number of applications. For example,
E;ective education in handling and sanitizing medical devices can reduce
potential hazards to healthcare workers and patients.