Yuhei Saito

Microbial contamination of surgical instruments used for laparotomy

BACKGROUND The aim of this study was to determine the risk of contamination of surgical instruments according to the type of instrument and the surgical procedure. METHODS Microbiologic examination was conducted on 140 pairs of forceps used in 24 elective laparotomies. These included 60 pairs of tissue forceps and 80 pairs of DeBakey forceps. Microbes on their surface were recovered using a membrane filter method. Adenosine triphosphate assay was also performed simultaneously in each pair of forceps. RESULTS A total of 66 strains of microbes was recovered from 44 collected instruments (31%), with microbial counts ranging from 0 to 296 colony-forming units. Among the recovered microbes, gram-positive cocci were dominant [corrected]. The remaining microbes included 6 strains of gram-positive rods and 4 strains of gram-negative rods. The most common organism was Staphylococcus epidermidis, followed by S hominis and S warneri. Residual adenosine triphosphate was not correlated with the number of recovered microbes. CONCLUSION Surgical instruments tend to be contaminated during operations by microbes that inhabit the skin and organs. Surgical instruments could act as fomites for the pathogens of surgical site infection even if the surgical field is not apparently contaminated, through application of appropriate practices adhering to surgical site infection guidelines.

Prevention of medical accidents caused by defective surgical instruments

BACKGROUND The malfunctioning of surgical instruments may lead to serious medical accidents. Limited information is available on the risk of defective instruments. The purpose of these study is to demonstrate the features of defective surgical instruments, to establish a strategy to reduce the risk of medical accidents. METHODS We studied 19,474 consecutive operations during 2007 to 2009 at our hospital. The data on defective instruments were collected based on the orders for repair of broken instruments and reports of near-miss incidents. Adverse events caused by defective instruments were also identified from reports of near-miss incidents. RESULTS A total of 1,775 nonfunctioning instruments were identified during the study period. Of these, 112 were found during operation. More than half of the defective instruments were tissue-grasping instruments, bone-boring/gnawing instruments, and instruments for endoscopic surgery. Wearing out and inappropriate use of instruments were 2 major causes of defects. The rest of the causes consisted of inadequate inspection and factory defects. Two near-miss incidents (incidence 10 per 100,000 operations) in endoscopic surgery were potentially critical, but the postoperative course was uneventful in each patient. The incidence of defects adjusted by the number of operations demonstrated that bone-boring/gnawing instruments and instruments for endoscopic surgery tend to be broken during surgery. Without inspection by the manufacturer, the incidence would be much higher for endoscopic instruments. CONCLUSION Our data suggest that the appropriate use and adequate inspection of particular types of instruments are key for reducing the risk of medical accidents caused by defective surgical instruments.

Challenging Residual Contamination of Instruments for Robotic Surgery in Japan

BACKGROUND Recently, robotic surgery has been introduced in many hospitals. The structure of robotic instruments is so complex that updating their cleaning methods is a challenge for healthcare professionals. However, there is limited information on the effectiveness of cleaning for instruments for robotic surgery. OBJECTIVE To determine the level of residual contamination of instruments for robotic surgery and to develop a method to evaluate the cleaning efficacy for complex surgical devices. METHODS Surgical instruments were collected immediately after operations and/or after in-house cleaning, and the level of residual protein was measured. Three serial measurements were performed on instruments after cleaning to determine the changes in the level of contamination and the total amount of residual protein. The study took place from September 1, 2013, through June 30, 2015, in Japan. RESULTS The amount of protein released from robotic instruments declined exponentially. The amount after in-house cleaning was 650, 550, and 530 µg/instrument in the 3 serial measurements. The overall level of residual protein in each measurement was much higher for robotic instruments than for ordinary instruments (P<.0001). CONCLUSIONS Our data demonstrated that complete removal of residual protein from surgical instruments is virtually impossible. The pattern of decline differed depending on the instrument type, which reflected the complex structure of the instruments. It might be necessary to establish a new standard for cleaning using a novel classification according to the structural complexity of instruments, especially for those for robotic surgery. Infect Control Hosp Epidemiol 2017;38:143-146.

Novel concept of cleanliness of instruments for robotic surgery

Robotic systems for surgeryhavebeendevelopedover the last 30 years, and currently use of the da Vinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) predominates in many countries. Robotic systems provide surgeons with many benefits such as refinedmanipulation of surgical instruments. On the other hand, they bring about difficulty for personnel in central sterile supply departments, because these instruments may be difficult or impossible to clean adequately. This article discussesconcernsabout thecleanlinessof robotic instruments.

Development of System for Managing Individual Surgical Instruments by RFID

Among medical errors, surgery provides environments that are particularly vulnerable to malpractice and in which a single case of such malpractice could create a threat to the life of a patient. In this study, with the aim of implementing individual data management of surgical instruments using RFID tag, we developed a RFID tag that can be attached to surgical instruments. On clinical site, in order to implement individual management for surgical instruments, we focused on repeating sterilization characteristics, Durability and contamination tests during washing processes at medical site, impact resistance against falls.

Concerns Associated With Cleaning Robotic Surgical Instruments—Response to Wallace

Affiliations: 1. Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2. Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran; 3. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Address correspondence to Saeid Safiri, Assistant Professor of Epidemiology, Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran (saeidsafiri@gmail.com). Infect Control Hosp Epidemiol 2017;38:1013–1014