The potential for hackers to exploit remote access systems to infiltrate a healthcare organization’s networked devices and systems is the number one health technology hazard that hospitals should focus on in 2019, according to the ECRI Institute.
Such attacks can disrupt healthcare operations, hinder the delivery of care, and put patients at risk, the nonprofit research organization warns in its just-released 2019 Top 10 Health Technology Hazards.
Produced each year by ECRI’s Health Devices Group, the list identifies potential sources of danger that ECRI believes warrant the greatest attention for the coming year. The list is accompanied by practical strategies hospitals and healthcare providers can take to reduce the risks.
Cybersecurity is clearly a growing concern. In the past 18 months, the ECRI published 50 cybersecurity-related alerts and problem reports, a major increase over the prior period, the group notes.
“The consequences of an attack can be widespread and severe, making this a priority concern for all healthcare organizations. In critical situations, this could cause harm or death,” David Jamison, executive director of the Health Devices Group at the ECRI, said in a news release.
Organizations need to identify, protect, and monitor all remote access points and adhere to recommended cybersecurity practices, such as instituting a strong password policy, maintaining and patching systems, and logging system access, the group says.
Taking the number 2 spot on the latest top tech hazards list are mattresses and mattress covers that remain contaminated with blood and other bodily fluids after cleaning, posing an infection risk. “Healthcare facilities must take care to use appropriate products and procedures for cleaning and disinfecting mattress covers, and they should regularly inspect mattresses and covers for signs of damage or contamination,” the group advises.
“One key challenge, however, is that not all mattress cover suppliers recommend products and procedures that will successfully remove the likely surface contaminants without compromising the cover’s integrity (ie, creating weak spots that could allow leaks). This situation needs to be remedied,” they conclude.
Number 3 on this year’s list are surgical sponges unintentionally left inside the patient after the surgical site is closed, which can lead to infection and other serious complications, including the need for another surgery.
Manual counts, in which the surgical team verifies that all sponges are accounted for before concluding the procedure, are standard practice, but errors in counting can occur, the group notes. “Technologies that supplement the manual counting process are available and have been found to be effective when used correctly. ECRI Institute contends that broader adoption of these technologies could further reduce the risk that a surgical sponge will be unintentionally retained during a procedure,” they say.
Number 4 on the list is improperly set alarms on ventilators, which put patients at risk for hypoxic brain injury and death. “Properly set alarms can prevent such consequences. Yet ECRI Institute continues to investigate deaths resulting from breathing circuit disconnections during which no alarm activated. In two cases from early 2018, alarms to detect inadequate ventilation, such as the minute-volume and low-pressure alarms, were not set appropriately,” the group notes. “Healthcare facilities need policies on setting user-adjustable ventilator alarms and protocols for verifying that the policies are being followed and that component connections are secure.”
Number 5 on the list is mishandling flexible endoscopes after disinfection, which can cause infections in patients. Cleaning and disinfecting flexible endoscopes between uses can be challenging, and failure to adhere to a strict reprocessing protocol can lead to infections. “Less well known is that improper handling and storage practices can recontaminate previously disinfected scopes, heightening the risk of patient infections,” the group notes.
When endoscopes are not completely dried after disinfection, any remaining viable microbes can rapidly proliferate and colonize the instruments. “To promote drying, ECRI Institute and relevant professional societies recommend purging endoscope channels with clean air at the end of the reprocessing process,” the group states.
The “clean” status of endoscopes can also be compromised if the instruments are handled with unclean gloves, which the ECRI has observed. “Endoscopes that have been cleaned but not yet high-level disinfected are still contaminated with viable microbes; thus gloves used to handle an endoscope at that stage must not be used to remove the scope from the reprocessing machine,” they caution.
“Recontamination can also occur when transporting and storing endoscopes. Disinfected and dried endoscopes should be transported in a clean enclosed container, dedicated to that purpose, and should be prevented from contacting potentially unclean surfaces,” they add.
The Final Five
Rounding out the top 10 technology hazards ECRI says warrant the greatest attention in the coming year are the following:
6. Confusing dose rate with flow rate, which can lead to infusion pump medication errors.
7. Improper customization of physiologic monitor alarm settings, which may result in missed alarms.
8. Injury risk from overhead patient lift systems.
9. Cleaning fluid seeping into electrical components, which can lead to equipment damage and fires.
10. Flawed battery charging systems and practices that can affect device operation.
More information about the ECRI ranking is available on the group’s website.