Friday, January 2, 2009

Reusing syringes

About 2 months ago, I caught the end of a radio story and heard that hundreds of patients were going to have to be tested for HIV and Hepatitis. I wondered what had happened. Later in the day, I learned that at a hospital north of here, it had been discovered that nurses administering sedation for endoscopy and dental procedures had for years been using the same syringe between multiple patients. Later we learned that this had been routine practice at another hospital in another province. These stories occupied the front pages of newspapers for days and I believe a few people lost their job over it. Our health authority got into the act by issuing a stern warning against the practice.

One of advantages of aging is that one gets to see the evolution of practice and how yesterday's standard operating procedure becomes today's horrified headline.

In 1986 when I started my residency the re-use of syringes by anaesthetists was routine. There were degrees of this. One prominent anaesthesiologist who we called Dr. Bob used the same 4 syringes all day. (His son-in-law who worked in the same department had to go to elaborate lengths hide the syringes he threw away). Other anaesthetists would switch syringes but often put the contents of a multi-dose amp like fentanyl or droperidol into a syringe which they used all day. There were extremists who preached against the re-use of syringes including our department chair who made dire threats against any resident he caught re-using syringes. (This same individual threw away a brand new laryngoscope after using it on the first known HIV patient to come to the OR).

Partially due my fear of the chief, my distaste for Dr. Bob and common sense lead me to decide that I would not re-use syringes. In my first job as a staff anaesthesiologist I quickly noted that by the end of the morning I would run out of syringes and have to be re-supplied. This lead me to believe that I was the only person who didn't re-use syringes. One exuberantly unrepentant anaes. proudly used the same 4 syringes all day. This fellow was also known for never having mixed up a bottle of pentothal. At some point in the day you would spot him out of the corner of your eye refilling his partially empty syringe out of your pentothal bottle. During my brief tenure as quality assurance person for the department I did raise the issue of re-use of syringes. He stated when there was evidence that it was a bad thing he would stop but frankly he found it wasteful to throw away syringes. He had for years blocked the adoption of circle systems by the department which meant we still used Bain circuits with their 5 L / minute flows. Because it was common knowledge that he (and other members) re-used syringes, at the end of every day, every non-virginal multiple dose bottle, no matter how large and expensive had to be thrown out.

One thing nobody commented on in the press was that the danger to the patient's health of having a nurse administer sedation to them was probably much greater than the risk of catching any blood-born disease.

While I don't know why they did it or what they used, I do have some suspicions about what was going down. I suspect that the nurse was using meperidine for sedation and rather than having to go thru the hassle of signing out a dose for each patient, was signing out multiple doses at the beginning of the day and drawing them all up into a single syringe. She also may have been using propofol or even midazolam.

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