The investigators found stained surgical equipment and encountered a surgery that had to stop because the surgical team lacked the proper equipment, according to the report.
These new findings prompted VA Inspector General Michael Missal to write a letter to the acting VA undersecretary for health and members of Congress Wednesday detailing the deficiencies.
“These further incidents raise serious concerns that surgeries and other procedures requiring sterile equipment may be performed with unsuitable equipment,” the letter reads, according to USA Today. Mr. Missal asked for immediate action to be taken so veterans would not be put at risk.
A statement from a VA spokesperson, sent to USA Today, noted that the patient in the most recent incident was not harmed. However, the VA sent sterilization specialists and two surgical nurse managers to the DC hospital who will provide “temporary support and oversight.”
More articles on patient safety:
10 latest healthcare hand hygiene findings
CMS can do more to validate hospital-reported infection data, OIG report finds
Changing gloves during C-sections reduces wound complications
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