Hacker News Reader

Comment by univalent | Hacker News Reader

Pro tip: if getting a colonoscopy, always always get the first appointment of the day. I work in med devices and ummm those scopes still have poop left over between procedures. Its not harmful, but still...

View on HN

Huh. I asked my retired endo nurse mom about that, and she said (at least at her hospital), that’s not possible.

So, I’d recommend not going to the hospitals this dude services.

I'm no expert but aren't you exposing one patient to the previous patient's poop? There could be anything from a lovely c-diff payload to something the next guy is allegeric to like nuts. As a layperson it hardly seems harmless.

I have a feeling OP means they are sterilized or autoclaved but some (now non-dangerous) particles remain as there is no medical point in thoroughly cleaning them after sterilization. Which would make sense.

People get a bit paranoid about how "clean" things are. I for one am not as concerned about how "clean" something looks but how potentially harmful it is to my livelihood. Looks can be deceiving, either way, without considering the entire situation.

Something that looks unclean can be sterile and harmless while something sterile and visually clean can be incredibly harmful as well (e.g. water with certain toxins or compounds).

Exactly.

The first (not sure if reputable) article I came across regarding this suggests that this is absolutely a major public health concern and maybe people working in medical devices passing it off as harmless is part of the problem...

https://www.focusforhealth.org/need-a-colonoscopy-the-one-qu...

Wait for real? How would that not be insanely dangerous and risky in terms of fecal cross contamination and disease transfer? Do you have a source for standard treatment procedure to not include using a sterilized scope?

Company that tried and failed to make a sheath: https://www.giejournal.org/article/S0016-5107(08)00014-X/abs...

Some of the clinical challenges https://www.sciencedirect.com/science/article/pii/S200103701...

With the exception of an actual emergency (i.e. "We need to see inside them or they will die, we'll deal with the infection risk later) doing this in most hospitals I know is one of the better ways to sign up for the infection control team paying you a visit.

If they're not being cleaned adequately report it to the medical board.

Why are they not cleaned thoroughly? Just curious.

And if they are and yet still contain fecal matter, how does going in the next day help? Your appointment is still after someone else's. Do they use a new scope?

Theoretically, some bacteria could have died overnight, which would be good. In general, simple instruments constructed of stainless steel or other solid non-porous materials are easy to wash off and autoclave. Complicated constructions in which multiple parts fit precisely inside other parts constructed of different materials are not easy to wash and autoclave. Scope manufacturers would be encouraged to design more sensibly if physicians could be held accountable for cross-contamination. This would require a more aggressive regulatory regime.

I am trying to make sense of the original post while stipulating that the claim about it not being harmful is true. Assuming only sterile fecal matter is left on the device, how does having an appointment the next day help?

He seems to be suggesting that the fecal matter can be avoided by a gap of 16 hours versus a gap of (say) 30 minutes. I'm at a loss for the mechanism by which this might occur.

I work on the video side of things and know nothing about the mech eng part. What I can tell you is that during the day there is definitely fecal matter in the scope one case to another during the day after after autoclave and sterilization. The first case of the day, the scope is clean. I don't know what's different about overnight processing in the sterile processing department. And I've seen this at many hospitals. There's been some startups that have tried sheaths to cover the scope but could not make it work.

The difference you cite between the per-patient and daily cleaning, disgusts any human who learns of it. The only studies showing that sort-of clean scopes are safe were funded by the scope manufacturers. This is problematic.

There are design issues currently being worked on to minimize crevices and spaces where bacteria may remain (redesign) or avoid the issue completely (design and implement disposable endoscopic heads)

Reply on news.ycombinator.com