The Reused Probe and the Sterilization Log
You are covering for a colleague at a small clinic. In the treatment room you find a galvanic probe that was wiped with an alcohol pad and returned to its holder between clients; the previous electrologist's note says "probe disinfected between clients, replaced weekly." The autoclave log shows entries for the past two weeks in identical handwriting with identical times. The sharps container is three-quarters full and unlabeled. A client is scheduled in 20 minutes for a 45-minute session. The clinic owner is out of town and unreachable.
1. What is your immediate course of action before the next client arrives?
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The probe practice is a breach: a probe that penetrates skin is a critical item and requires sterilization between clients, not alcohol disinfection. Alcohol does not achieve sterilization and is not appropriate for a critical instrument. The identical log entries suggest the log may have been fabricated, meaning you cannot rely on it as evidence that any instrument was properly processed.
Before the next client, stop and reset. Do not use the suspect probe. Use a sterile, single-use probe from sealed packaging, or a properly processed reusable instrument only if you can verify the cycle. Set up a fresh treatment station, label and replace the sharps container, and document the condition you found with times and specifics. If you cannot establish a safe setup in time, delay or reschedule the client rather than proceed. The client's inconvenience is minor compared with a bloodborne pathogen exposure.
2. What do you do about the records and the colleague, given the owner is unreachable?
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Document objectively and contemporaneously: what you observed, where, when, the state of the log and sharps container, and the actions you took. Avoid conclusions about intent in the record; state facts. Notify the owner in writing through the established channel and keep a copy. Depending on jurisdiction, there may be a duty to report unsafe practice to a licensing or public health authority; determine the requirement rather than assume.
Regarding the colleague, do not confront accusatorially in front of clients. Raise the concern through the proper channel once the owner is reachable. In the meantime, protect clients by controlling the supplies and station you use. If clients treated under the suspect practice may have been exposed, that is a matter for the owner and possibly public health authorities to assess; preserve the records rather than altering them. Altering or backdating the log yourself would compound the problem.