Filthy Surgical Instruments may lead to Patient Infection, which may in turn lead to Medical Malpractice Suits against Hospitals.

In 2009, John Harrison, a then 63 year old oil industry sales manager in Mission, Texas, had surgery to repair the rotator cuff in his right shoulder, a routine procedure that usually requires at most a single night’s stay in the hospital, followed by physical therapy. For Harrison, however, there was nothing routine about the ordeal that ensued, which eventually led to Harrison filing a medial malpractice lawsuit against the hospital that rendered his treatment.

According to the Center for Public Integrity’s iwatch News, in the weeks following the surgery, his scar turned bright red, hot to the touch, and oozed thick fluid that looked “like butter squeezed from a bag.” Alarmed, Harrison’s wife, Laura, called The Methodist Hospital in Houston, where the surgery was performed, to inform them of the problem. That night, surgeons opened up Harrison’s shoulder and found that infection had eaten away part of his shoulder bone and rotator cuff. After Harrison underwent surgery to remedy these issues, 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 suffering from personal injuries for months at a time, dependent on hired nurses, unable to dress himself, take a shower, or work, and afraid for his life.

Harrison at first blamed himself, thinking he had not taken proper care of his surgical wound. The truth was much worse: Harrison was one of at least seven joint surgery patients at Methodist who acquired dangerous infections during a two-week period. The outbreak led Methodist to close operating rooms and cancel knee and shoulder surgeries while hospital and Centers for Disease Control and Prevention (CDC) investigators searched for the cause.

They found two likely sources in unlikely, yet terrifying, spots, deep inside a handheld power tool called an arthroscopic shaver, which surgeons use to shave away bone and tissue during surgery, and inside a long narrow metal tube called an inflow/outflow cannula, which is used to irrigate and suction the surgical site.

According to the Center for Public Integrity’s iwatch News, during the Methodist investigation, the hospital inspected surgical tools with a tiny video camera to make sure places impossible to see with the naked eye were clean. They were not. Inside the cannulas and arthroscopic shavers, the video camera made startling finds. Human tissue and bone were stuck in both devices. The camera also discovered a bristle from a cleaning brush in an arthroscopic shaver. Further investigation revealed that Methodist had not cleaned the cannulas with brushes, as manufacturer instructions require. Instead, the hospital ran tap water through the instruments.

The case of the dirty arthroscopic shavers, however, was even more frightening. According to accounts by Methodist staff and a government infection control researcher, the hospital followed the cleaning instructions provided by Stryker, the Kalamazoo, Michigan manufacturer of the shavers used on all the infected patients. The instruments had been properly cleaned, but they were still dirty. That set off alarms that would travel through the larger medical community. Dr. Pritish Tosh, a former investigator at the Centers for Disease Control and Prevention Epidemic Intelligence Service, blames the Methodist infections on those dirty devices. Investigators say hospital-acquired infections are notoriously difficult to track to their sources, but Tosh’s account is likely the only explanation Harrison is going to get for why he endured seven follow-up surgeries, but still cannot raise his arm when he wakes up in the morning.

“I’m angry,” said Harrison. “This is 2.5 years. I should be at the time of my life where I need to enjoy it a little bit.” In 2011, Harrison filed a lawsuit against Stryker and Methodist. Early this year, Harrison settled with Methodist for an undisclosed amount. His case against Stryker has been moved to federal court. Although Stryker declined to comment, paperwork the company filed in court denies Harrison’s claims, arguing among several defenses that the firm’s arthroscopic shavers “conformed with the prevailing standard and customs of the state of the art of the industry.”

Unfortunately, the Methodist case was not a fluke. Filthy, dangerous medical implements have been showing up in hospitals and outpatient surgery centers with alarming regularity. In 2009, the Department of Veterans Affairs admitted that 10,737 veterans in Florida, Tennessee and Georgia were given endoscopies or colonoscopies between 2002 and 2009 with endoscopes that may have been improperly cleaned. Some of those patients later tested positive for HIV, hepatitis C, or hepatitis B. Several lawsuits filed against the VA by veterans are currently working their way through the courts, and attorneys expect many others to follow. Investigation of a 2008 hepatitis C outbreak that sickened at least six people in Las Vegas revealed that an outpatient surgery center was improperly cleaning endoscopes and reusing biopsy forceps designed for a single use. Following that outbreak, a Centers for Medicare and Medicaid Services (CMS) pilot program inspected 1500 outpatient surgery centers and cited 28 percent for infection control deficiencies related to equipment cleaning and sterilization.

It is difficult to know exactly how often dirty instruments are to blame for the infections that plague hospitals, since bacteria can hide anywhere from a doctor’s unwashed hands to a nurse’s dirty scrubs. But experts say it happens far more often than generally understood. “The cases we hear about,” said Dr. Melissa Schaefer, a CDC medical officer, “are only the tip of the iceberg.”

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