看看这个原来是普遍现象啊。。。。
The use of disposable devices has become an increasingly common component of
medical and dental patient care. Items classified as disposable are defined
as single-use, and are intended to be used on one patient, then discarded.
They are not to be processed for reuse on another patient. The advantage
disposable products have as compared to reusable products is inherent in the
reality that disposable devices reduce the potential for patient-to-patient
cross-contamination and possible cross-infection. This advantage, along
with their ease of use and time savings from reprocessing procedures,
provides a rationale for including this approach in current health
professional infection-control guidelines. Numerous examples are found in
dental facilities. These include gloves, masks, prophylaxis cups, patient
bibs, syringe needles, and environmental surface covers. There is also a
class of products that are available as either disposable or reusable items.
In recent years, the trend has shifted to the disposable side. This is
demonstrated in the fact that most recent dental graduates do not realize
that their teachers and mentors reused plastic saliva ejectors, high-volume
evacuation tips, impression trays, and air-water syringe tips.
While an inspection of medical and dental dispensary areas would show a
variety of single-use, disposable patient-care items, one question remains.
Are they being used as mandated and directed by the manufacturer? As strange
as this may sound, consider these two points:
① The health professions aren’t too far removed from a time when “reuse”
was more common than “disposable.”
② Compliance with recommended procedures and precautions continues to
present challenges to accepted infection-control goals.
Besides the examples for the first point, many dental clinicians recall
using the same pair of latex gloves during treatment of multiple patients.
Gloves were changed when they became sticky from washing with a liquid
antiseptic, or when they developed visible defects. Reuse of plastic saliva
ejectors and prophy cups, after washing and immersion in chemical
disinfectants, was also common. Despite this trip down infection-control
memory lane, another important question lingers. Were these practices the
most dangerous documented misuses of disposable devices?
A recent Boston Globe article on hospital reuse of medical devices meant to
be discarded after a single use stated patients were unaware of the practice
. Evidence included improperly cleaned and sterilized surgical instruments
and catheters, which subsequently were used on other patients. Regulatory
agencies have dealt with this problem. A 1999 survey conducted by the
National Center for Policy Analysis investigated hospital recycling of
medical items. Nearly half of the 132 hospitals surveyed did reuse medical
devices designed for single use. Plastic catheters were among items
inappropriately reused.
Long term, clinical evidence is not available for the cross-infection
potential presented by reuse of most disposable devices. There is, however,
documented information to show how reuse of disposable needles and other
sharp devices presents substantial risks for exposed patients. This was most
recently demonstrated in a CDC report of four hepatitis outbreaks among
patients from 2000 to 2002. One of these outbreaks involved routine reuse of
syringes and needles by a nurse anesthetist during clinic sessions. By the
time the investigation of cases was concluded, 69 hepatitis C virus and 31
hepatitis B virus infections were identified as likely being retraceable to
this person’s practice. The nurse anesthetist ceased reusing needles after
a complaint was filed by staff nurses. Since then, no evidence of HCV or HBV
transmission associated with treatment has been detected.
Although a lack of compliance with basic infection-control practices for
single-use disposable needles and syringes was apparent and serious in this
instance, misuse of other disposable devices may not present with the same
indirect infection risks. The most common outcome may be a lessening of the
overlap and effectiveness of one’s total chain of infection control. The
ripple effect caused by a seemingly minor infraction can reduce the margin
of reinforcement and overlap each component of a prevention program provides
to the other components. The FDA repeatedly has taken the position that it
is not aware of any data that would establish conditions for the safe,
effective cleaning and subsequent resterilization and/or reuse of any
disposable medical devices. The FDA has urged those who reprocess devices to
submit additional data to show their procedures are safe. Keep this in mind
if you see someone misusing an item that was not manufactured to withstand
deterioration or provide maximum effectiveness with repeated and prolonged
use on more than one patient.