Dive Brief:

• The Government Accountability Office has found the Veterans Health Administration is failing to adequately oversee the reprocessing of endoscopes and other reusable medical equipment.

• Investigators found the VHA lacks complete inspection reports for sterile processing services and that the effectiveness of these services is threatened by insufficient staffing.

• The watchdog has told the VHA to improve the collection and analysis of inspection reports and examine workforce needs to ensure veterans can access safe healthcare.

Dive Insight:

Veterans Affairs Medical Centers use reusable medical equipment (RME) in the care of the 9 million veterans enrolled in the VHA’s healthcare system. After each endoscope, surgical instrument and other piece of RME is used, it must be cleaned, disinfected or sterilized to ensure it is safe for use on the next patient. The challenge of ensuring sterility has increased as devices have become more complex, culminating in an endoscope cleaning taking more than one hour of active work.

The VHA has put a RME reprocessing system in place to ensure equipment is clean and ready for use when needed. Failure to adequately enforce this system could lead to patients being infected or the delay or cancellation of procedures due to a lack of properly reprocessed devices.

​​The VHA and its medical centers have struggled with RME reprocessing in the past. In 2009, two VAMCs warned 10,000 veterans that they may have been exposed to hepatitis B, hepatitis C and HIV because they were treated with poorly-processed endoscopes. Two years later, GAO found that the VHA had failed to ensure VAMC were up to speed on reprocessing. The issues have continued to mount up. A report in March detailed reprocessing-related delays.

The congressional watchdog identified sources of the VHA's reprocessing problems. In its report, GAO takes the VHA to task for failing to ensure VAMCs are following its policies. Annual inspections by the Veterans Integrated Service Networks are supposed to give the VHA a look at practices at VA medical centers. However, GAO found the VHA was missing inspection reports for 27% of the center's sterile processing units. There is no evidence that 8% of the inspections were performed.

Without access to the reports, the VHA cannot meet its responsibility to oversee RME reprocessing. The reports that are available suggest there is room for improvement. GAO found issues related to quality and training were the most common causes of nonadherence. That finding chimes with other observations made by GAO, which is concerned that the sterile processing units struggle to hire and retain qualified staff.

GAO is recommending the Under Secretary of Veterans Affairs for Health examine the workforce needs of VAMC sterile services units, while also ensuring that inspection reports are consistently collected, analyzed and used to guide improvements.

The VA agreed with the report's recommendations and pledged to set up an oversight process for site inspections and reporting. It said it would analyze the findings in a written briefing on its website by July 2019.