Notes from the field: “Doctor, what is that in your hand?”

By: July 22nd, 2010 Email This Post Print This Post

I was almost done with my mock OSHA inspection in an OB/GYN office, and the last section of my survey covered decontaminating and disinfection.

One of the physicians was leaving an exam room holding a metal vaginal speculum in a paper towel. I could not believe what I was seeing! Luckily I didn’t collide with him, but I saw him soon enough to follow up on my concern.

But before that, I immediately conferred with the office manager to see exactly how the practice handled this issue. I found out that the physicians always wrapped the vaginal specula in paper towels and dumped them in/on the sink. Whoever had free time washed them with soap and water, using a brush to remove the debris. The specula were then placed on the autoclave tray to be processed.

On other mock inspections, I have seen staff members carry the vaginal specula out of the exam room in a dishpan, no lid, no soaking solution.

Believe it or not, I have heard that some practices have actually placed the washed specula in the break room dishwasher!

OSHA regulations clearly define vaginal secretions as OPIM (other potentially infectious material) therefore specific decontamination policies must be followed.

These are the guidelines I have implemented for my clients using metal vaginal specula:

  • These devices are classified as “semi-critical” and should be autoclaved if possible.
  • If the practice does not have an autoclave, use a high level disinfectant.
  • In the exam room/procedure room where this examination is performed there must be a covered container ready and available for the dirty specula.
  • A detergent solution/enzymatic cleanser should be in the transport container. This will help to loosen the bioburden prior to cleaning.
  • After the procedure, place the specula in the container, close the lid, and transport to the decontaminating area.
  • The staff member should don gloves, or other PPE if sprays and splashes are anticipated and wash the specula using a brush while holding the instrument under the water in the cleansing solution. Rinse well under running water.
  • Dry the specula and proceed to sterilize in an autoclave or follow the manufacturer’s instructions for high-level disinfection.
  • If you are using Glutaraldeyde, comply with the required OSHA regulations for vapor levels, eye wash stations, PPE, and room air exchange recommendations.
  • Once the specula have been disinfected, store it in a clean, dry area, not in a drawer with dust balls, staples, or thumb tacks!

Comments

Thank you for this article. It is unbelievable that in this day and age we still have to fight this kind of battle, yet those of us who are the “in-the-trenches” safety officers fight it every day. Could you please site the OSHA standard that you have based your advice on? I have many “where is that written” types within my pratices. I want to be sure I am quoting the correct place. Thanks.

By Kathy Potts,LPN on July 27th, 2010 at 8:53 am

Thank you for “Doctor,what is that in your hand?”.The practice where i work has dealt with that…presently, what is being done is as soon as the doctor has completed the exam, the metal spec is placed in a red bio-bag(which is heavier than what is in the bio trash containers).The assistant sprays down the spec while it is in the bag with a Sklar Spray-Zyme to keep it moist and carried to the autoclave room and placed in a box that has a red bio bag in it.(Gloves should be worn)Then I take the spec and rinse off the spray-zyme under running water,spray down with disinfectant,3min,
wait time then rinse,put in detergent pan.Clean off, lubricate,lay out to dry then autoclave.This is working out much better than what was happening in the past.

By Claudia Bueso, BSN RN on December 3rd, 2010 at 7:13 pm

I am an american instructed RN that ended up working in Honduras a developing country.
The the OB/GYN clinic that Im currently working is using the specula that had being washed on bottled water, Chlorine, washed then placed 1 hr in Chlorhexadine Gluconate, then rinsed with bottled water. Done. On top of that the Nurse Chief claimed that it was “International Best Practice” to clean/”sterilize” in that way.
I was about to pass out, but I had a sheet of paper with the instructions on doing the procedure. I looked for any references.. In other words “Says who?”. I really dont know how to deal with the situation, because I feel highly uneasy about doing pap smears using their “So called” Clean specula~!
Any advice?

Did you ever provide the references needed for this practice of transport?

PS I disagree about putting solution in container. This, in itself, could be risk for spills. If they take to decon area right after use, this shouldn’t be needed. Alternatively, the spray could be used. I also assume this practice would be not only for specs but for all contaminated instruments corect?

By Linda Auger on August 26th, 2014 at 12:04 am

I went to my pap smear and I was waiting for the dr. I began snooping through the supplies. To my surprise there was a dirty metal vaginal spectum in the bottom draw. So I then called my husband into the room and told him to make sure the dr. didn’t use the spectrum in the draw. When the exam was over, my husband told me she didn’t use the dirty one in the draw she took one out of her right pocket. Aren’t they supposed to open them in front of patients?

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It’s disturbing that specula still aren’t required to be autoclaved when basic disinfection does not kill HPV. Once again, women’s health is thrown to the wayside and no one cares. How much time and effort does it take to autoclave the specula? Would it bankrupt the hospital to do so? No? Then why don’t they treat them like scalpels? It’s a good thing that I don’t have HIV or hepatitis because I bleed every time I have a smear. I do have HPV. It’s a shame that the instruments used in me can infect other women.

I was seeing a Dr. Duque for a pap. While getting undressed in the file room that also functions as an exam room I noticed that the speculum on the sink looked as if it had been run through the autoclave dirty. Dried lubricants around the end. When the dr comes in we begin to talk I’m describing my pain when she pics up the speculum goes to a drawer. I thought she was getting a clean one while I was on the table. I heard a scraping noise while we were talking. When I was getting dressed I noticed only 1 speculum in the sink. Which meant her filthy habit was to scrape the junk off and use it on me. When the results came back I was told I had HPV as I’m asking questions she grew angry yelling at me while her front desk clerk stood there laughing. I changed drs that day. Later I was told I had herpes after bloodwork. I’ve never had an outbreak but always wonder if it came from this incident. Wish I was an OSHA representative bc I’d shut her practice down!

After my yearly routine gynecology pap I had issues with what appeared to be while heads on my vaginal area . Went back to the PA who did my original pap and was told I had HPV . I had not been sexually active in 10 years ! I told her this and she said it could remain dormant for that long . Oh bs ! I know I was infected the day of my pap , I believe it was from a reused , improperly cleaned speculum .
Now I’m doomed with the cancer causing hpv .
Also due to the hpv , I’ll never have another intimate relationship. Depressing and outrageous that this has happened .

 

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