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The following is issued on behalf of the Hospital Authority:
The spokesperson for Alice Ho Miu Ling Nethersole Hospital (AHNH) today (August 25) made the following announcement regarding a surgical equipment sterilisation incident:
AHNH's Central Sterile Supply Department (CSSD) has been using steam sterilisers to handle sterilisation cycles for surgical equipment. To ensure safe processing of surgical instruments, various sterilisation process monitoring tests are routinely performed, including mechanical, chemical and biological indicators in accordance with the prevailing standard. On August 18 and 21, two steam sterilisers were used for sterilisation cycles at 121 degrees Celsius and were routinely tested with the biological indicator. The test results were positive. The tests were immediately repeated with a new batch of biological indicators and were also positive. The tests conducted concurrently with both mechanical and chemical indicators were negative.
According to the test records of the mechanical, chemical and biological indicators, the latest biological indicator tests with normal results were conducted on August 10 and 17. As a precautionary measure to ensure patient safety, the CSSD suspended the steam sterilisers concerned from service, issued a recall of the potentially affected equipment and traced the affected patients.
The hospital is highly concerned about the incident and has started to contact a total of 40 affected optical patients to explain the incident in detail and arrange follow-up appointments. At present, none of the patients concerned who attended the follow-up have indicated clinically abnormal events. Given the normal test results of the mechanical and chemical indicators conducted during the said period in sterilisation process, the risk of infection is relatively low.
The vendor arranged to undertake operational acceptance testing of the steam sterilisers concerned, and the operation was found to be normal. To further enhance patient safety, the use of the 121-degree C sterilisation cycle has been suspended for the two sterilisers. The 121-degree C sterilisation cycle would only be used if absolutely necessary, and would be tested with mechanical, chemical and biological indicators to ensure the integrity of the sterilisation. The hospital will also conduct independent validation on the two sterilisers concerned.
The hospital has reported the matter to the Hospital Authority Head Office via the Advance Incident Reporting System. AHNH will continue to follow up with the vendor on the cause of the abnormal test results with the biological indicator.
Ends/Tuesday, August 25, 2015
Issued at HKT 19:52
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