Hospital's sterilising facilities 'borderline'

Auckland City Hospital's instrument sterilisation department has been of "borderline" clinical safety, says an independent review.

The hospital appointed the two reviewers, nominated by the Royal Australasian College of Surgeons, after continuing complaints since the newly centralised, $10 million sterile supply service (SSS) opened in 2003.

Their report, made public yesterday following hospital visits in December and January, concludes: "The SSS ... is considered to be borderline in terms of clinical safety. Improvement in the immediate future is seen as essential.

"There must be considerable improvement before the SSS can be regarded as clinically safe beyond reasonable doubt."

The reviewers, John Simpson, a college executive and Wellington surgeon, and Professor David Theile, the clinical director of surgery at Princess Alexandra Hospital in Brisbane, also looked at problems with the computerised clinical records system and outpatients administration.

The Herald revealed last year that when Auckland City Hospital surgeons reached for instruments, they sometimes found they were missing or contaminated with flesh - albeit sterilised - from a previous patient.

Failures to sterilise two batches of instruments in November and January put six hospital patients in Auckland at risk of catching infectious diseases, although none did.

The reviewers say the risks to patients of the sterile supply problems are infection risks "at the limits of acceptability" and prolonged operation and anaesthesia times.

The hospital says it monitors these and has found no increase in patient harm. Surgery infection rates have remained stable or improved since the new sterile service began.

The hospital acknowledges the shortcomings of the service and says the issues identified in the review have been or are being dealt with. It maintains it is clinically safe to continue operating the new system while making improvements.

The new service was meant to be a big step forward, but struck problems from day one.

"It became clear that our preparedness for the magnitude of this change was underestimated," the hospital's general manager, Nigel Murray, said yesterday. The hospital listed improvements of the service, including the use of digital photographs to help in packing the instruments that surgeons request, better training and new audit methods.

The review says that at the sterile supply's low point last June, 12.4 per cent of operations or procedures resulted in a report of an instrument problem, declining to 5.8 per cent in January, and the service has suggested a target of 3 per cent.

But the hospital maintains that when all instrument use is included, the figure is lower - around 4.2 per cent for January - and the international benchmark is 3 to 5 per cent.

The Chief Medical Officer, Dr David Sage, said staff training had become a major issue since instrument sterilisation changed in 2003 to a complex operation.

Previously no formal qualifications were required, but a certificate programme had been created and the hospital wanted 80 per cent of the 80 fulltime-equivalent staff to complete it by the end of this year.

What went wrong

* Surgical instruments at Auckland City Hospital were sometimes contaminated with human flesh from a previous patient, even after sterilisation.

* The failures put six hospital patients in Auckland at risk of catching infectious diseases.