ECRI Blog

Every day, hospitals’ central sterile processing teams rely on water as they clean and sterilize a variety of medical devices. In this blog, ECRI outlines general considerations to support safe and effective water preparation and use.

Water Quality Categories

There are three categories of water used to process medical devices. The first is utility water.  Utility water is suitable for use for point-of-use treatment of a device immediately after patient use, but is not drinking water quality.  Utility water is suitable for use for point-of-use treatment of a device immediately after patient use. The temperature of water used for this purpose should not exceed 45C/113F to prevent coagulation of blood and fixation of proteins on the instrument. This water is used for most parts of medical device processing—including flushing, washing, and intermediate rinsing. The notable exception is the final rinse.

Glucagon-like peptide receptor agonists (GLP-1 RAs) now available to promote weight loss—Wegovy (semaglutide), Zepbound (tirzepatide), and Saxenda (liraglutide)—could potentially make much needed gains against the obesity epidemic; however, the benefits of these medications come at a significant financial cost to patients and payors and the risk of rare but serious adverse events. Making sure the medications reach the right patients—those most likely to derive long-term benefits with low risk—will be critical to make the most of GLP-1 RAs. Prescribers will lead that effort by identifying and recruiting eligible patients, which is a difficult task because obesity is a complex disease; therefore, prescribing information will need to be interpreted in the context of each patient’s unique characteristics and circumstances. Furthermore, old and new misconceptions about obesity and weight loss drugs—now amplified and reinforced by social trends and media—can predispose patients and make discussions with physicians difficult.

ECRI recently published our Top 10 Patient Safety Concerns for 2024 Special Report—the annual guide that calls attention to pressing patient safety concerns facing the healthcare industry.

For this report, we draw on evidence-based research, data, and expert insights from ECRI and the Institute for Safe Medication Practices (ISMP). But we do more than highlight where concerns exist; we also provide encouragement and education to support organizations in addressing them with a Total Systems Safety approach. 

International Women’s Day is an opportune time to celebrate improvements in women’s health outcomes—and reflect on steps we can take to achieve even more progress. For this blog, we’re focusing on a specific women’s health issue: cervical cancer. 

Years ago, this form of cancer was one of the most common causes of cancer deaths among women in the U.S. But between 1955 and 1992, the incidence and death rates declined by more than 60%. Credit goes to the development of the Papanicolaou test—commonly known as the Pap smear or Pap test.

One of the most effective cancer screening tests available, the Pap smear helps clinicians identify cervical intraepithelial neoplasia (CIN) and remove it before it progresses to cervical cancer. The test also enables detection of cervical cancer at an early stage.

Roughly one year after their introduction, Wegovy (semaglutide) and Zepbound (tirzepatide) continue to shake up the obesity treatment landscape in the United States. Uptake for these two glucagon-like peptide receptor agonists (GLP-1 RAs) has surpassed expectations and is driving demand for Saxenda (liraglutide), an older GLP-1 also indicated for weight loss, along with off-label use of Ozempic (semaglutide) and Mounjaro (tirzepatide), two GLP-1 formulations indicated for treating diabetes. The reason for this is clear: a large body of clinical evidence shows the drugs can help patients lose 15% to 25% additional weight when used alongside evidence-based lifestyle interventions (counseling, diet, and exercise). These effects are greater than those seen with older weight loss medications (typically ~5% total weight loss) and close to typical weight loss seen with bariatric surgery.

The prevalence of overweight and obesity keeps worsening in America despite our enormous collective effort to lose weight. The U.S. Centers for Disease Control and Prevention estimates that overweight and obesity now affect over 70% of Americans and add over $170 billion to annual U.S. healthcare costs. About half of Americans try to lose weight each year, and social trends constantly shift around a myriad of weight loss interventions and products. Among these, weight-loss-inducing medications have historically received limited attention. However, public interest and demand for weight loss drugs has spiked since the introduction of two new drugs: semaglutide (Wegovy) in 2022 and tirzepatide (Zepbound) in 2023. 

This year, ECRI and the Institute for Safe Medication Practices PSO celebrates our 15th anniversary as an AHRQ-listed Patient Safety Organization. Over this decade and a half, we have worked tirelessly to build and maintain the trust and reputation that confirms ECRI and ISMP’s deep roots in safety . In our 15 years as a PSO, we have collected close to 6.5 million safety events, including over 4.4 million adverse events (events that reached the patient and caused a degree of harm), 880,000 near misses (an adverse event was averted), and 1.2 million reports of unsafe conditions (events that could have led to patient harm). Behind those numbers are the stories of people: moms and dads, sons and daughters, friends and neighbors, who have been unintentionally harmed in our health systems. However, there are also stories of brave healthcare team members who recognized the risk for harm and had the courage to speak up for safety, intervene, and catch that near miss before the patient was harmed. With our immense database of safety events comes a great responsibility to learn from these stories and understand the failures in our healthcare systems that lead to harm.  The learning and action that result from these events is how we will demonstrate our constancy of purpose for improving patient safety. 

Isolation gowns are a longstanding infection control tool across hospital settings. These garments are intended to safeguard patients and clinicians by preventing the spread of disease-causing microorganisms. But do today’s disposable gowns provide the degree of protection healthcare workers assume? Not necessarily.

ECRI believes there is a disparity between healthcare workers’ perceptions and actual gown performance. Consider, for example, this 2012 survey of infection preventionists. It found that about one-quarter of these professionals encountered strikethrough and 45% encountered tearing of gowns. What’s more, while a sizable portion had seen issues related to disposable gowns, half lacked the training to understand why. 

Ventilator-associated pneumonia (VAP) is a lung infection that develops 48 hours or more after initiating invasive mechanical ventilation. Mechanical ventilation assists breathing in patients who have weak respiration and cannot independently breathe sufficiently to remain alive. Examples of invasive mechanical ventilation techniques include endotracheal intubation and tracheostomy. In endotracheal intubation, a physician places a long endotracheal tube in the patient's trachea (windpipe) through the mouth. In tracheostomy, the trachea is accessed through a small incision on the patient's neck. Tracheal secretion accumulation during intubation is a high risk factor for VAP, which can be caused by lung and lower respiratory tract colonization with microorganisms.

A home care client suffered infection and leg amputation after an employee allegedly trimmed dead skin off the client's foot with rusty scissors that had been used to cut off a soiled diaper. In a lawsuit brought against the agency and the employee, the Supreme Court of New York, Appellate Division, First Department, has affirmed denial of the agency's motion for summary judgment, allowing the suit to continue.

The employee used rusty scissors to cut the client's soiled diapers, then used the same scissors to cut dead skin off the client's foot, according to the allegations. The client suffered a foot wound, which became infected. Ultimately, the client required an above-the-knee amputation.