Everything old is …

Nurses of my vintage are surely smiling at the “news” that it may be possible to re-use some of the very expensive equipment that is routinely disposed of in hospitals today.

There was a time when most of the equipment used in patient care was re-useable. It was scrubbed after use, returned to the Central Supply Room (CSR) where it was rescrubbed, disinfected, sterilized and repackaged. Nurses were trained in the opening of these packages so that a sterile field was maintained and the instruments that were removed with rubber-gloved hands were pristine.

As disposable equipment began to take over, we saw basins filled with stainless steel instruments and hampers filled with strong cotton wrappings replaced by vast garbage bags filled with plastic — packaging and equipment. To this day, the disposal of all this plastic is an environmental issue.

It was also the beginning of an era that saw the lay-offs of hospital workers who were responsible for the 24-hour-a-day CSRs and the general weakening of housekeeping departments that were responsible for the cleanliness of the hospitals. Today, hospitals contract out their “cleaning” services and it is fair to say that the private sector workers who are hired to clean hospitals don’t have the same motivation and dedication to the work as an earlier generation of publicly-employed hospital workers.

Has the use of plastic disposable equipment cut down on infections? I haven’t done the research but I would be surprised to find that rates of in-hospital infection are any lower than they were a generation ago when there were autoclaves in use all day on each floor, when even bedpans, washbasins, kidney basins and other bedside utensils were scrubbed and disinfected on a regular basis.

It’s difficult writing this to avoid a “back in my day” tone. So I will concede that certain equipment should be used only once — let’s say bladder catheters, for example. And all nurses are/should be thankful for disposable needles. Those old needles could get very dull and burred.

But I am firmly on the side of the health authorities who are going to look into the possibility of returning to the use of some equipment that can be reused.

The subject was raised during Question Period in the Nova Scotia Legislature yesterday, September 23, by Karen Casey, the leader of the third party (Tory). The responses were made by the Premier, Darrell Dexter (NDP).

HON. KAREN CASEY: Mr. Speaker, my question is to the Premier. Capital District Health Authority will be hiring a company to reprocess medical equipment previously designed for one-use only. Will the Premier explain the rationale behind this decision?

THE PREMIER: Mr. Speaker, I certainly would like to thank the Interim Leader of the Progressive Conservative Party for the question. The district health authorities, of course, have control over their own budgets. They make these decisions based on what they think is both in the best interest of their patients and in the best interest of the district health authority as a whole. So they’re making that decision understanding all of the ramifications and quite frankly, I have faith in their judgment in that regard.

MS. CASEY: Mr. Speaker, one Halifax cardiologist has said an ultrasound catheter is an example of equipment that could be used more than once because “it has least chance of reinfection.” The words “least chance of reinfection” are disconcerting. Is the Premier prepared to accept full liability should anything happen to any patient at Capital Health as a result of this practice?

THE PREMIER: Mr. Speaker, I’m sure the Interim Leader of the Progressive Conservative Party understands that these matters are reviewed by the medical staff, they are reviewed with the district health authorities. They rely on medical expertise when they make their decisions and as I said, I’m certainly not a physician, I rely on their advice as I’m sure the Leader did when she was responsible for the ministry.

MS. CASEY: Mr. Speaker, I’m very well aware of the role and responsibility of the government. The risk of this practice is too great. A savings of $150,000 pales in comparison to the life of a Nova Scotian. Any comments regarding liability insurance, if anything should happen to a patient, do not instill much confidence in patients at Capital Health. To the Premier, will the Premier stand in his place today and agree to put a stop to this practice before it begins and thus ensure that the health of hundreds, indeed thousands of Nova Scotians, will not be put in jeopardy? Mr. Premier, you know and Nova Scotians know, the buck stops with you.

THE PREMIER: Mr. Speaker, that’s an example of a question that was written before the answer was heard. I didn’t mention liability insurance, what I mentioned was the medical expertise of the district health authority. It’s their responsibility; they, of course, make these judgments based on the sound expertise of their staff and, of course, we rely on them.

 

The question unnecessarily sensationalized the issue and asking if the Premier would accept personal responsibility for the fate of hospital patients was a little disingenuous.