If you ask your doctor where a single-use anal catheter has been before the doctor uses it on you, there should be only one answer: in the packaging. Any other answer should be unacceptable. Single-use anal catheters are not like bowling shoes. They are not meant to be re-used.
Unfortunately, according to Spencer Kent reporting for NJ.com, Dr. Sanjiv K. Patankar, a colorectal surgeon based in East Brunswick, NJ, may have overlooked the “single-use” portion of the name. The New Jersey Board of Medical Examiners has suspended the medial license of Patankar for allegedly reusing disposable single-use anal catheters on multiple patients. Anal catheters include tubes that are inserted into a patient’s rectum to either inject fluids or obtain fecal matter samples. As you can imagine, anal catheters can get quite dirty while being used, hence the reason for single-use disposable ones.
However, from January 1 to November 30 this year, Dr. Patankar’s office reportedly performed 82 procedures requiring the catheters but only ordered five catheters over that time period. Do the math and you’ll realize that this would mean that a given catheter was used on at least 16 different patients. Apparently, rather than disposing the catheters after a single use, Dr. Patankar and his staff washed the catheters between uses.
That can be a bit like washing and then reusing used toilet paper. Neither toilet paper nor single-use catheters are designed to be washed, making them difficult to adequately clean and disinfect. Microbes such as bacteria and viruses can hide out in the various cracks, crevices, and pores in the catheter. Besides sounding rather disgusting, such unacceptable re-use can help transmit infectious diseases from one patient to another. Moreover, washing can significantly damage any device, equipment, or material that is not designed to be washed. This can not only impair the functioning of the catheter but also create more cracks, tears, and other places for microbes to hide.
Reusing medical devices that are labelled as single-use devices can be an attempt to save costs. In 2008, Laura Landro wrote a piece for the Wall Street Journal on how hospitals were employing such a practice for a variety of medical devices such as scrubs, scissors, and surgical knives. An article in CMAJ by Roger Collier claimed that a quarter of hospitals in Canada and the U.S. do so. Beyond saving money, proponents argue that reuse is better for the environment by reducing medical waste and that medical device companies are trying to make more money by selling devices as single-use when they could safely be multi-use devices. Multi-use may be appropriate if there is a proper amount and degree of scientific evidence that reuse and washing of that particular device will not compromise safety and performance. Moreover, well-documented and well-monitored cleaning and testing processes have to be in place. Just because one hospital or one person can thoroughly clean a device one time doesn’t mean others will do so other times. Finally, clinics and hospitals must be transparent about their reuse policies and procedures. No device can be reused indefinitely. There’s a difference between reusing a pair of scissors 3 times versus 1,783,347 times.
While there may be appropriate reuse of certain medical devices, no one wants to be victim of inappropriate reuse such as what allegedly occurred with anal catheters. So here are some precautions that you may want to take:
- Choose your doctors, clinics, and hospitals carefully. If possible, don’t sacrifice quality by trying to save money. Do your research. Make sure that your doctor has the appropriate background, training, and qualifications. Get a sense of whether the clinic or hospital is in cost-cutting mode and how that may affect quality of care and patient safety.
- Scan the surroundings: Are the office space, examining room, procedure rooms, and surrounding environment clean? Pay attention to places that don’t immediately catch the public eye and may be overlooked such as the trash cans, the bathrooms, the back offices, and under furniture. Dirty and poor upkeep may be a sign that the clinic or hospital is trying to cut costs by cutting corners and skimping on hygiene.
- Familiarize yourself with every procedure you will receive. Know what equipment will be used, including what can and cannot be reused.
- Inquire about procedures used to clean and check equipment. The spray that is used on bowling shoes at bowling alleys is not an acceptable means to clean medical devices.
- Watch the equipment being taken out of their packaging. A common practice is opening the packaging in front of you so that it is clear that new equipment is being used. Be wary of packaging that looks like it has been re-sealed, re-taped, or re-anything.
- Be wary of any signs of damage, wear and tear, or hygiene issues. Brown spots may be a fashion statement in some situations but don’t belong on many medical devices.
- Ask to see and read the packaging: Check whether the device is labelled as single-use. Reading the packaging will also help ensure that they are employing the proper equipment.
- Ask how the devices and equipment are handled. You have a right to know how everything is cleaned and stored. Also, inquire about the clinic’s or hospital’s reuse policy. If you are told that a single-use device is being reused, check or ask for the evidence that such a practice is safe.
Any reluctance to answer such inquires should raise red flags. Anything that may affect patient safety should be as transparent as clear plastic packaging. After all, medical devices aren’t the same as bowling shoes in many, many different ways.