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June 30th, 2010
04:01 PM ET

Why HIV exposure at hospital may have happened

A lapse in protocol for cleaning dental tools is linked to possible HIV and hepatitis exposure at a Missouri veterans hospital.

At issue, reportedly, is that the instruments were hand-washed before being put in a sterilizing machine. But how is that bad?

Proper procedure would have been to send them to be both sanitized and sterilized by machine, according to CNN affiliate KSDK.

An object with residual biological material on it cannot be sterilized, said Steve Streed, member of the Association for Professionals in Infection Control and Epidemiology's board of directors.

Normally, dental instruments at the hospital would be put in a washing device to dissolve biological debris; simply washing with soap and water won't get it off, he said.

The sterilization process itself cleans microbes; it does not remove debris, he said. Thus, washing the tools with soap and water could have contributed to people becoming exposed to virus.

This is the second recent case of a hospital alerting patients about potential infection. This month, Palomar Hospital in San Diego, California, sent letters to 3,400 patients who underwent colonoscopy and other similar procedures. Items used and reused in the procedures could have resulted in potential infection, the letters said.


soundoff (22 Responses)
  1. OldTechie

    This is nonsense - to quote "HIV is very fragile and does not survive well outside the human body. HIV is inactivated by heat and dies after 30 minutes at 56EC (132.8EF). It is also highly susceptible to physical and chemical agents." Sterilization invovles temperatures > 100C for > 15min. Where is the risk from hand cleaning even if particles are left?

    June 30, 2010 at 16:57 | Report abuse | Reply
    • Hn

      You don't have a clue what you are talking about. How can you guarantee that something inside the particle doesn't survive and which then can get transfered and infect the next patient?

      June 30, 2010 at 17:31 | Report abuse |
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  2. T.NWALA

    Old te is right surport of oledtr writheup

    July 1, 2010 at 05:07 | Report abuse | Reply
  3. Can

    Perhaps people with HIV should have tools used on them that are ultimately destroyed.

    July 1, 2010 at 08:41 | Report abuse | Reply
    • K

      great idea, but what about the people who have HIV, Hep B or C and don't know it – a person can be without symptoms for some time and still be contagious. That's why there are universal precautions – you can't assume that someone doesn't have an infectious disease so you protect yourself and everyone by treating each patient the same way

      July 1, 2010 at 09:29 | Report abuse |
  4. Al

    No, Hn, it is you who does not have a clue. Old Techie is absolutely correct. The diffusion of heat at 100 oC into small particles is virtually instanteneous. It would take a microsecond for a microscopic particle to reach temperatures of 100 oC. Such temperature, according to all the years of information (misinformation?) fed to us, should destroy HIV instantly. Somebody is selling us a BIG LIE, but I am not sure who and why.

    July 1, 2010 at 09:01 | Report abuse | Reply
  5. Joe

    The referenced article is very vague and, in fact, dangerous. If you’re going to scare thousands of people into thinking they may have contracted HIV or Hep C you deserve to give them a better explanation. According to the CDC, instruments MUST be cleaned before being sterilized, and hand cleaning is a perfectly acceptable way for doing this. So I still don’t see from that article what these people did wrong. Hand cleaning is needed to remove debris (organic and inorganic) from an instrument or device BEFORE sterilization. If visible debris is not removed, it can interfere with microbial inactivation and can compromise the disinfection or sterilization process. Debris can be removed from an instrument either by scrubbing the instruments manually with [soap] or by using automated equipment and chemical agents. So you shouldn’t immediately jump to the idea you’ve been infected by reading the article in question. A much better explanation must be provided than this yellow-journalistic sensationalist article before anyone worries. This was more deserving of a Tabloid than an acceptable news source.

    July 1, 2010 at 09:27 | Report abuse | Reply
  6. Intrigued

    It is clear that HIV is fragile outside of the body and does not live very long once exposed. However the question at hand is what was the sterilization technique used by the facility? Again if the company simply used soap and water to sterilize the instruments then there is no guarantee that the water that was used was at a temperature that was high enough to kill the microbe on the instruments. Moreover the fact of the matter is that sterilization and technique are the fundamental parts of patient care. How can something so simple such as ensuring that equipment is sterilized before being placed in the autoclave go unnoticed?

    July 1, 2010 at 09:36 | Report abuse | Reply
  7. Navybill

    Suggest all of you move off this subject. Joe is correct.

    July 1, 2010 at 09:42 | Report abuse | Reply
  8. jabber

    Ok listen this is my point of view: (1) protocol is there for a reason use it! (2) this is what people get when those people cut corners! (3) have suprise inspections on the people who are in charge of that procedure (4) Fire them if they are not doing the correct way of the job, this could go on forever but see my point!

    July 1, 2010 at 13:35 | Report abuse | Reply
  9. mACBONES

    A stick with a non-hollow bloody needle through a surgical glove carries an extreme low risk, so I would imagine no one has actually gotten HIV from this. HEPC is another case altogether, and has a high transmission rate and is relatively sturdy. Nonetheless, I suspect this is all lawyer fodder and will be an excuse for a lawyer to make millions off the taxpayer.

    July 1, 2010 at 14:25 | Report abuse | Reply
  10. gagagirl

    guess what....we're all going to die!!!!!!!!

    July 1, 2010 at 14:31 | Report abuse | Reply
  11. brownie1

    THIS IS SERIOUS PEOPLE!!!!!!!!

    July 1, 2010 at 15:38 | Report abuse | Reply
  12. shanno

    For those people who say HIV dies outside the body in 30 Minutes- would you please tell us if you would have a dental tool that was not properly cleaned as per protocol used on you- I certainly would not, but I am a health care professional and know better.

    July 1, 2010 at 15:54 | Report abuse | Reply
  13. tesiemc

    The medical profession kills around 100,000 people a year, IN THE UNITED STATES!! That doesn't even count the many who live but are messed up. And they constantly barrage us with how we "need" this treatment and that treatment. Buncha scumbags. Occasionally... and I mean VERY occassionally.... they are useful. But Nature will have its way, regardless.
    I, for one, would rather give what little I have to my children than line the pockets of people who only want to sell me the latest treatments and drugs, leaving me miserable and broke for the short life that may be left.

    July 1, 2010 at 16:39 | Report abuse | Reply
    • tesiemc

      And, I'd like to add that this sounds like a VERY bogus excuse. I'll keep away from hospitals, thanks.

      July 1, 2010 at 16:41 | Report abuse |
  14. Vetswife

    The problem here goes far beyond whether the HIV survives or doesn't survive. It tells us what all us suspect is true in many places within the VA system. The staff does not care about their patients. I'm not sure why but we have all seen it. All protocols and procedures should be followed without fail. They are there for a reason and medical people are trained to follow them. So, why do we keep hearing about those who do not–both within the VA and in the private sector? It is not acceptable to do your job halfway and it is my hope that some heads roll over this and any other incident. Infuriating!!

    July 2, 2010 at 16:35 | Report abuse | Reply
  15. dentalvet

    I am a veteran. I also work in a VA dental clinic not the one Missouri. I was a dental assistant in the military and now at the VA. There is a lot to say and I am not even sure where to start. First the finding of the inspection "Dr. Gina Michael, the association chief of staff at the hospital, told the affiliate that some dental technicians broke protocol by hand washing tools before putting them in cleaning machines." What? This statement does not make any sense to anyone who works in a medical or dental facility. Nor should it make sense to anybody with common sense. Why would hand cleaning something make it unsterile before sterilizing it? Then the CNN anchor interviews the congressman and says the instruments were just hand washed not sterilized. Unfortunately we are getting conflicting reports at our meetings to. At the VA the procedure is such:
    1- Wipe all debris (blood, bone, tissue, and cements) off instruments.
    2- Soak instruments in enzyme solution.
    3- Wash and rinse instruments in cleaning solution.
    4- Put the instruments in a ultrasonic cleaner
    5- Put instruments in medical washing machine.
    6- Wrap instruments or put them into medical bags.
    7- Sterilize in Autoclave.
    On top of that the Autoclave is checked on a daily basis. We run a vacuum test on the first load to make sure it has proper steam pressure. Then on the second load we run a spore test to make sure it is killing all the pathogens. Nothing is 100% but the VA and the Military are the best at infection control and dental sterilization. We get checked by JACO and our own VA inspectors the IG (Inspector General). Now unfortunately I have to tell you that at the private dental office that most receive dental care, more than likely they do not do half the procedures we do. Private dental offices do not get inspected by any agencies, government or civilian. Most do not sterilize their handpieces (drills), they are just hand cleaned. They don’t even throw away the burs that go into the handpieces. The burs are just hand cleaned and used again until they are dull or break. We use a new bur for every patient. In private dental offices the instruments are just wiped down, bagged or wrapped then put into a small table top Autoclave. They more than likely do not run daily tests on their Autoclaves, if any at all. Private dental offices do not have the money, staff and most important the time to follow our sterilization and infection control procedures. Now how many people do you know that contracted anything from going to the dentist? Now how many people do you know contracted food poisoning from a restaurant? You use the same silverware that thousands of other people use and not one time are they sterilized. In my opinion the IG found miniscule things and the leadership at the Missouri VA made a bad decision by sending those letters to vets. Because the chances of the vets contracting something are next to nil and sending those letters just caused panic.

    July 3, 2010 at 21:35 | Report abuse | Reply
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