Health Technology: The Top Ten Hazards

The ECRI Institute, a nonprofit foundation devoted to evidence-based medicine, has just released its second annual listing of the ten biggest dangers posed by various healthcare technologies — and, perhaps more important, how to avoid them. This is a huge service, given that medical errors remain one of the largest preventable causes of death in the U.S.

For some reason, however, ECRI only released the top five hazards in its press release; to get the full report, it wants to harvest your email address in hopes of signing you up for its newsletters — and, mostly likely, selling you a journal subscription or access to its more detailed reports.

So as a service to BNET readers, here’s the full list, ordered by decreasing severity:

1. Alarm hazards. Alarms on devices ranging from patient monitoring equipment to ventilators and dialysis units are intended to improve clinical practice and protect patients. But ECRI says alarm issues are among the most commonly reported concerns it receives. Such problems include devices that issue too many nuisance alarms (causing hospital staffers to tune them out), nurses and other staffers that improperly set alarms to medically unrealistic levels, and clinical layouts that make it difficult to hear and respond to alarms.
2. Needlesticks and sharps injuries. Despite protective devices on many needles and IV sets, ECRI argues that these injuries keep happening, putting medical staff, patients and waste-disposal workers at risk of wounds or contracting diseases such as HIV and hepatitis. The institute recommends properly training staff in the handling of sharps and carefully evaluating protective features, since some are better than others.
3. Air embolisms from contrast-dye injectors. Dye injectors are commonly used in angiography to image the heart and its blood-vessel system, but they can sometimes also inject air bubbles into the blood, with potentially fatal consequences. Safety systems on these devices aren’t fullproof, so ECRI suggests — you guessed it — proper staff training and regular inspections of the embolism-prevention features.
4. Retained devices and unretrieved fragments. Yes, surgeons sometimes leave sponges and even instruments inside patients, and doctors sometimes unknowingly break off the tips of instruments like catheters. ECRI recommends more training and inspections, although it also notes the emergence of new systems designed to help track surgical sponges, which may also eventually be used for other devices.
5. Surgical fires. Yikes! Electorsurgical devices, cauterization systems and lasers can sometimes cause operating-room fires, particularly when patients are receiving supplemental oxygen. Recommendation: Ensure proper handling of still-hot disposable components, limit the pooling of oxygen and keep potential fuel such as alcohol swabs and hospital gowns well away from “ignition sources.”
6. Anesthesia hazards. Too many times, hospital staffers fail to properly inspect anesthesia systems before operations, ECRI says, and recommends better training and inspection procedures.
7. Misleading displays. Many device displays simply stink, ECRI says (OK, technically the institute calls them “ambiguous or counterintuitive”), and can lead doctors or nurses who rely on them to give patients incorrect drug doses or make improper diagnoses. The institute recommends specifically assessing the display on new devices before purchase and informing the manufacturer when problems occur.
8. CT radiation dose. CT scans are convenient and reliable, but they can also expose patients to high levels of radiation. Avoiding those requires carefully assessing whether a CT is really necessary — which, of course, runs the risk of alienating patients who demand them — optimizing scanning protocols to limit radiation exposure and educating doctors about radiation risks so they can exercise restraint in referring patients for scanning.
9. MRI burns. Although many medical folks think flying metal objects, which can get caught up in the powerful magnetic field of an MRI machine, are the biggest hazard presented by these devices, patient burns are apparently much more common, ECRI says. Preventing them requires watching the placement of conductive cables and pulse-oximetry sensors and the use of manufacturer-supplied padding instead of blankets for wrapping patients.
10. Fiberoptic light-source burns. The fiber-optic cables used in endoscopy and similar procedures can burn patients when handled carelessly, as can heated cable connections. ECRI recommends proper procedures and device inspections.

ECRI also notes that five of its previously listed hazards have dropped off the list this year — not because they’ve become any less significant, but because the current top-ten problems are more urgent. FYI, here are the “lost” five hazards:

• Burns during electrosurgery
• Caster failures
• Infusion pump programming errors
• Misconnection of blood pressure monitors to IV lines
• Radiation therapy errors