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Contaminated Endoscopes the Top Health Tech Hazard

Contaminated endoscopes and in particular, duodenoscopes, are the ECRI Institute's top health tech hazard for 2016, following a year of news about infectious bacterial outbreaks and ineffective reprocessing practices.

Contaminated endoscopes and in particular, duodenoscopes, are the ECRI Institute's top health tech hazard for 2016, following a year of news about infectious bacterial outbreaks and ineffective reprocessing practices.

Marie Thibault

 

The Emergency Care Research Institute (ECRI Institute) this week released its Top 10 Health Technology Hazards for 2016 and the top concern is ineffective cleaning of flexible endoscopes, an issue that made headlines throughout 2015 for outbreaks of carbapenem-resistant enterobacteriaceae (CRE) infections at hospitals around the United States.

Contaminated flexible endoscopes are not new to the group’s yearly hazards list—it was the fourth item on the 2015 list and sixth on the 2014 list.

This year, dirty duodenoscopes, which are a type of endoscope used to diagnose and treat diseases of the liver, bile duct, and pancreas, were a focus for FDA too. The agency issued final guidance on reprocessing of reusable medical devices, held an advisory committee meeting in May, and issued more recommendations on duodenoscope reprocessing in an August safety communication.

For its 2016 list, the ECRI Institute authors wrote in an executive brief that “Facilities need to emphasize to their reprocessing staff that inattention to the cleaning steps within the reprocessing protocol can lead to deadly infections.”

Second on the 2016 list is the safety issues around missed alarms, which was the number one issue on last year’s list and remains a key priority for the ECRI Institute. “Failure to recognize and respond to an actionable clinical alarm condition in a timely manner can result in serious patient injury or death,” the ECRI report states.

Here is the full list of top health tech hazards for 2016:

  1. “Inadequate Cleaning of Flexible Endoscopes before Disinfection Can Spread Deadly Pathogens
  2. “Missed Alarms Can Have Fatal Consequences
  3. “Failure to Effectively Monitor Postoperative Patients for Opioid-Induced Respiratory Depression Can Lead to Brain Injury or Death
  4. “Inadequate Surveillance of Monitored Patients in a Telemetry Setting May Put Patients at Risk
  5. “Insufficient Training of Clinicians on Operating Room Technologies Puts Patients at Increased Risk of Harm
  6. “Errors Arise When HIT Configurations and Facility Workflow Do Not Support Each Other
  7. “Unsafe Injection Practices Expose Patients to Infectious Agents
  8. “Gamma Camera Mechanical Failures Can Lead to Serious Injury or Death
  9. “Failure to Appropriately Operate Intensive Care Ventilators Can Result in Preventable Ventilator-Induced Lung Injuries
  10. “Misuse of USB Ports Can Cause Medical Devices to Malfunction”

Which issues do you think deserve to top the list? Are there any issues missing that you think should be included? Let us know in the reader poll below!

 

Check out the future of medical technology—register for the BIOMEDevice San Jose Conference, December 2-3, 2015.

Marie Thibault is the associate editor at MD+DI. Reach her at [email protected] and on Twitter @medtechmarie

[Image courtesy of STUART MILES/FREEDIGITALPHOTOS.NET]

 
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