Better sterilization or better disposable instruments?

A man died recently in Australia of what was thought to be possible “sporadic CJD, an illness that kills about 20 people in Australia each year.” The disease is different from variant CJD (also known as ‘mad cow disease’), but neither variety has a treatment or cure. Death usually occurs within six months of symptoms.

So this brain disease, apparently caused by a rogue protein and able to lie dormant for decades, is causing an uproar. It’s not that someone didn’t follow proper sterilization protocol, but they say if they had known he might have this disease they would have been even more cautious.

The problem is there is no perfect method of sterilization. Bits of tissue, bone or blood, or even water drops, can remain on an instrument that goes into a sterilizer and therefore mask that area enough to prevent sterilization. And of course not all “germs” die in the steaming process.

Add to this the variety of materials now being used for instruments (inlcuding plastics and fiber optics) and you compound the problem. Some companies are making reusable handles that have disposable inserts of various types (as in surgical scissors that uses a variety of disposable jaws).

The debate will always rage. The issues are cost, human safety and environmental friendliness. In non-medical terms, should we soil the environment with disposable diapers or threaten the water supply with the extreme amounts of detergent and bleach needed to clean cloth ones? How about putting garbage in landfills versus using the garbage disposal?

How do you judge which is the lesser of two evils? The number of people placed in danger? The ages of the people put at risk? Do we draw a line and say we shouldn’t go beyond this? These are questions human beings face everyday…some–like medical professionals–more than others.

As I said earlier about the debate on stem cell research, in vitro fertilization and pre-implantation diagnosis, the wisdom of the many must provide answers when the questions are ones that have never had to be asked before. Thank God we have the Internet with which to conduct our debates–makes it much more likely that we’ll hear all our voices.