DANGER!

The failure of the North West Regional Health Authorities to purchase new sterilisers is putting both workers and patients at risk. The Port-of-Spain General Hospital (PoSGH) has to send dressing packs and linen used for surgery and on wards to the Eric Williams Medical Sciences Complex (EWMSC) because it does not have a working steriliser. Delays and insufficient supplies have resulted in surgeries being postponed. Meanwhile, at EWMSC two Ethylene Oxide (ETO) gas sterilisers past their usable life span are still in service although the monitoring system which checks the air quality in the room does not work and there is no extractor fan to pull out the fumes. “We can’t tell if it is safe to enter the room to do sterilising since the monitoring system has been down for a year and a half,” a technician said in an interview.

In addition, there are only two steam sterilisers functioning to sterilise equipment from PoSGH, Chaguanas, Arima, St James Medical Complex, and Tobago. In November and December of last year a malfunction in the Ethylene Oxide (ETO) sterilisers at  EWMSC exposed two workers to Ethylene Oxide, a gas which can cause irritation to the skin, eyes, throat, nose and lungs. It can also cause damage to the brain and nerves. Fortunately, the workers suffered no side-effects. EWMSC is the only facility which provides ETO sterilising for equipment which are not suitable for steam sterilising (eg face masks, suction tubing). The first incident happened on November 30 last year. The two sterilisers were loaded and started as usual by a technician from the Central Sterilising and Supplies Department (CSSD). When she returned to retrieve the loads she noticed an error code — E50 — showing on the display. This can mean that either the plunger mechanism, which pierces the ETO canister is not working or there is an empty canister in the machine. When the technician opened the steriliser to check what was happening ETO gas erupted when she touched the canister. The plunger mechanism was subsequently replaced by 3M. 

Both sterilisers worked until December 9 when the same problem occurred as another technician attempted to check the canister. According to the US Agency for Toxic Substances and Disease Registry “increased incidences of leukemia and stomach cancer have been reported in workers exposed to ETO; however, the data are not considered conclusive.”  Since the mishaps, CSSD workers have refused to use the sterilisers. The technician said the CSSD manager has taken it upon herself to operate the sterilisers but is doing so “at her own risk.” In a memo to the Complex Administrator, Colin Bissessar dated December 11, 2002 the Manager of the Biomedical Department, Sydney Wellington said an official of 3M had said when the sterilisers were first installed a three-year contract was entered into between 3M and EWMSC, during which time regular maintenance procedures were carried out. However, when the contract expired it was not renewed, and 3M’s visits thereafter were “only on a breakdown basis.” Wellington also advised that the 3M official said the sterilisers were “way past their usable lifespan which he indicated is approximately 15 years. The sterilisers located at CSSD are over 20 years old. Because of this they have had to resort to cannibalising two of the existing units in order to keep the other two running due to the unavailability of parts.” The 3M official also recommended the replacement of the monitoring system.

The problems do not end there. Only two out of four autoclave machines (steam sterilisers) are functional. Two weeks ago a third machine spewed hot water into the air, luckily no workers were close by and this steriliser is now out of service. They are used to sterilise dressing packs and other equipment used at health facilities in the NWRHA, and Tobago. These sterilisers are said to be “creeping along” and prone to breakdown from overwork. Although the room where sterilised items are kept is enclosed, other areas lack air-conditioning.
“CSSD is supposed to have a good feeder AC to keep down infection, the place is very hot. We need our own individual AC because the main chiller for Mt Hope is down most of the time. It can only give a small feed to CSSD.” Technicians said they are working in a “danger zone” and the authorities are too lazy to take action in the interest of workers’ health and safety. Technicians are supposed to undergo a  medical every six months but this has not been implemented. A visit to the CSSD at PoSGH revealed years of neglect. The area is not enclosed or air-conditioned so workers keep the glass louvres open to keep themselves cool. Work stations are wooden counters and tables. Tiles are old and cracked. The shelves where dressing packs are kept are rusty and covered over with brown paper.

Sunday Newsday enquired when was the last time the area was cleaned but this question was met with laughter. “I can’t tell you,” the worker said although she has been working there since 1994. The CSSD has been without a functioning autoclave since 2001. It also does not have a functioning laundry. As a result, supplies must be sent to EWMSC. Surgery has been postponed because packs and linen were not available in time. “We don’t have a supply stocked up, one or two surgeries have to be put off every other day and by the end of the week there is a backlog of about nine surgeries..and that is for one theatre,” a worker complained. He is fed up of the system and the inaction by the authorities. One steriliser stopped working in June 2001 and the other “years before.” There is a small steriliser but this is used for smaller items like tubes. Over a year ago, Newsday reported  about the conditions at the CSSD. Since that time nothing has changed. The dressing packs prepared at PoSGH must still be sent to EWMSC for sterilisation. They are put into cotton sacks and transported to Mt Hope. After this process they are sent back to CSSD for distribution to operating theatres, wards, clinics, and the Accident and Emergency Department.

Tap water is used to wash instruments since there is no hot water and cold water available. A distiller to provide water for the surgical theatres, Maternity and Neo-natal departments has been out of service for many years. There has been a report circulating that the National Insurance Property Development Company (NIPDEC) has invited tenders for  refurbishment and this will start by the end of the year but workers are skeptical, saying “only God knows” when this will actually happen. The grouses of workers at Mt Hope and PoSGH do not end with complaints about their work environment. They want more training but the NWRHA is yet to respond. EWMSC technicians said there is no “follow-up” training while autoclave operators at PoSGH think the NWRHA must think they are foolish to ask for training and certification. Technicians at Mt Hope think they should be paid more since their work load has increased considerably and they are tired of appealing for new uniforms. Some of them wear the same uniform everyday, others work in their own clothes. One of them said cross-infection was possible since he is not sure what contaminants he is taking  home to his family. At PoSGH operators said they are waiting to be reclassified. They are still at Range 20 while orderlies and attendants have been upgraded.