Blood and body tissue has been found on medical instruments at Perth’s Fiona Stanley Hospital, placing the contract to provide the sterilisation service to the hospital in jeopardy.
The Western Australian Health Department warned it could take back full responsibility for the sterilisation process after service and outsourcing company, Serco, was issued with a second breach-of-contract notice.
Health department staff have been supervising the process since February, following a number of issues.
Western Australia’s Australian Medical Association (AMA) president, Dr Michael Gannon, said problems have continued.
“These reports are absolutely mind-boggling and they’re something that we don’t repeat with any relish at all,” he said.
“We have had reports even since the takeover, of instruments containing body tissues, being seen to be obviously bloodstained.”
Dr Gannon said while the situation is now better under health department supervision, it is still not good enough.
“There’s no question that Serco has expertise in a whole variety of areas based on their experience in other industries – but when it comes to sterilisations, Serco failed,” he said.
“There’s been some improvements but unless Serco can guarantee that we’re not [going to] go back to where we were before, they can’t have their contract reinstated.
“We’ve got great fears if Serco was left to take over this issue alone.”
While health department staff are involved in supervising the provision of the sterilisation process, Serco technically still hold the contract.
But that could change.
The Western Australian Health Department’s acting director-general, Professor Bryant Stokes, said the current level of service was unacceptable.
“We are not happy with the level, and that’s why we’ve sent this breach letter and that is why we are taking the extra precaution of having our staff in there at the moment, but we have not fully taken over the service at this point in time,” Professor Stokes said.
“We have given a notice of breach to Serco which they are responding to and we have to let that process run until Friday next week, and depending upon the response from Serco, we will then make a decision through the Minister as to what we do.”
Serco’s history of contract breaches
Serco was issued with a contractual breach notice on December 12, after instruments were found to be in the wrong trays and debris were discovered post-sterilisation, among other issues.
The health department took on a supervisory role in late February after problems continued, including trays not getting to theatre in time.
A second breach notice was issued on March 3.
Since then, there have been three incidents where foreign material was found in medical instruments.
Professor Stokes said that while the situation has generally improved under the supervision of the health department, the recent incidents concerning instruments that had allegedly been cleaned and sterilised were not acceptable.
“In all my years in surgery, I’ve known it to occur three or four times, and even a small fragment of bone is sterilised when it comes out of the steriliser, however it’s not appropriate,” he said.
“What has been of concern has been foreign material inside hollow-tubed instruments; these are sheath instruments.”
Cap dislodged in replacement heart valve
Professor Stokes detailed one particular incident involving a heart patient.
“There’s only been one issue in which a patient had a valve inserted in which there was a cap left off the sterilising component of the valve in the steriliser, and that has now been proven to be OK, but that’s the only patient in which something’s gone into them,” he said.
“The valve, when it’s being prepared for sterilisation, has a little seal cap on it – presumably to prevent any secondary contamination – this cap was found to be dislodged when the pack was opened.
“That patient is fine and has been checked and the cardiac surgeons are happy with that process.
“Whether it was on during sterilisation we don’t know – it has been placed in the patient, the surgeon was happy to do that, the patient has been very closely followed by the surgeon and is well.”
Numerous hospital contracts held by Serco
Instrument sterilisation is one of more than 20 roles Serco is contracted to perform at Fiona Stanley Hospital, which opened in stages from October 2014 through to February, by which time the emergency department was fully operational.
None of Serco’s other roles at the hospital have come into question.
Many hundreds of instruments are sterilised on a daily basis and there has been no suggestion that patient safety has been compromised.
But Professor Stokes said if incidents occur consistently, and regularly, then there is a problem.
He added that Serco does not appear to have had much experience in the area.
“I’ve asked that to Serco themselves, on two occasions, and they’ve told me they’ve had little experience.”
When asked why Serco was employed for the service, Professor Stokes said he did not know because he was not involved in the appointment.
Serco has to complete its response to the second breach notice by Friday, April 10.