AEGiS-Miami Herald: Opinion: Sloppy procedures put lives at risk

Important note: Information in this article was accurate in 2009. The state of the art may have changed since the publication date.

Opinion: Sloppy procedures put lives at risk

Miami Herald - Monday, March 30, 2009

Using good sterile technique is the first and most important thing that all healthcare professionals learn -- and with good reason. Failure to do so can kill patients. This is why it is so stunning and so competely unacceptable that equipment at several Veterans Administration hospitals, including in Miami, may have been improperly cleaned, exposing thousands of veterans to possible hepatitis or HIV infections. After the news broke came promises from VA hospitals for a thorough review of procedures and demands from members of Congress for investigative hearings. These audits and more are necessary. Putting lives at risk through carelessness is inexcusable.

Taking tests

The scene at the Miami VA hospital last week was clear evidence of the personal toll this crisis has caused. Hundreds of veterans, including some in fatigues and others in wheelchairs, poured into the hospital to take tests to determine if they've been infected. None of them could have imagined that their conscientious efforts to get a colonoscopy could put them at risk of contracting a life-threatening disease. Fortunately, the odds are in their favor. Experts say the risk of cross-contamination are extremely low, something on the order of one in 1.8 million.

Nevertheless, veterans all over the country now face a risk where there should have been none. The Miami VA hospital should face special scrutiny from investigators because of how it has handled the crisis. After being warned by the Department of Veterans Affairs in December about problems with colonoscopy equipment, the Miami hospital checked its procedures and reported that everything was fine -- only to later discover problems after a more extensive review.

VA hospitals have notified 3,200 patients in in Miami, 6,400 in Tennessee and 1,100 in Georgia that they may have been exposed to infections during colonoscopies since 2003. So far, 10 people from Tennessee and six from Georgia have tested positive for infection, although it hasn't been determined if the infections are from colonoscopies or some other treatment.

Exposure to HIV?

VA hospitals not just in Florida, Georgia and Tennessee but throughout the country have been given ample warning to follow basic sterile procedures. There can be no excuse for not doing so.

Members of Florida's congressional delegation, including Sen. Bill Nelson and Reps. Kendrick Meek and Ileana Ros-Lehtinen have expressed outrage about the possible exposure of veterans to HIV and other serious viruses. Sen. Nelson and Rep. Meek called for an investigation by the Inspector General. The outrage and calls to account are justified.
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