Single-use surgical instruments have become widely used over the last decade primarily because of the post “mad cow disease” era where the risk of contamination caused by the difficulty of cleaning and removal of proteins gained public recognition.
However, new clinical situations, commissioning of new facilities, arrival of new personnel and the well-publicised pressure on healthcare providers like the NHS has resulted in the emergence of many more reasons for deciding to use Single-use. For many these benefits are not immediately obvious and this article seeks to identify the “hidden” benefits of Single-use that may help deliver a better patient service in future.
These benefits can be categorised as the 4R’s – Reprocess, Repair, Replace, Risk, and the importance of each depends on the individual setting.
The First R – Reprocess
The reprocessing, or cleaning and sterilisation of reusable surgical instruments is a traditional activity in all hospital sterile services departments. The vast majority of instruments are manufactured to suit repeated processing for many years using durable materials and designs capable of straightforward cleaning. However, instruments like suction handles with lumens and bent patterns, like Fraziers or Zoellners have long been regarded as difficult to clean and therefore suitable for Single-use. Occluded instruments such as Spackman Cannula probably represent the strongest case for Single-use.
The growing recognition of protein mis-folding disease and the affinity of proteins to stick to stainless steel means the range of difficult to clean instruments has grown much wider. These instruments either require more time to clean effectively, which costs time and money, or become newer candidates for the Sterile Single-use alternative.
Beyond the efficiency of reprocessing, there are more clinical pressures on the need for a fast turnaround. This places further time pressure on sterile services and has the potential to slow or disturb patient lists in theatres and clinics. Single-use provides the opportunity to reduce this pressure and keep instruments available at the right time.
The Second R – Repair
In regular use, fine instruments, such as Crocodile Forceps, get damaged or misaligned. Similarly, cutting devices like biopsy punches and scissors, will become blunt with repeated use. In both cases repair or sharpening is the usual option which means tools are unavailable for use and the repair including shipping can be expensive.
In the case of scissors and biopsy punches the intervals between sharpening can be prolonged meaning that the efficiency of the device is compromised. In the case of biopsies this may mean samples are torn or damaged and pathology can only provide inconclusive results. In these cases, the patient is likely to be retained or re-tested providing additional pressure on resources at a time when the pressure is to reverse this trend.
Sterile Single-use provides a high quality alternative that can be used to replace those instruments that need to have optimum alignment or first time sharpness and be available at all times to suit busy clinical situations.
The Third R – Replace
Reusable instruments are capital equipment because of the lifespan of use. Instrument Curators manage their stock with care and replace worn out devices when required. However there are a number of circumstances where capital resources have to be used to buy new stocks.
Those reusables that cannot be sharpened or are beyond repair are the obvious group. However losses also occur particularly when there are remote sterilisation sites or in the case of fine or small devices and this can be a significant area of unbudgeted expense.
Although not strictly replacements, there are many examples of additional capital spend being needed to increase the capacity of clinical departments to improve, develop or expand the service to patients. Opening additional clinics running extra lists to cope with patient waiting times, places additional burdens on instrument demand that could easily result in surgeons waiting for trays to perform a procedure.
Sterile Single-use instruments are able to alleviate these pressures and of course can be utilised selectively for times of additional demand if required. From recent case studies, this option can also prove to be more cost effective.
The Fourth R – Risk
Cross contamination with the risk of surgical site infection represents the headline reason for Single-use. Extended stay or patient re-admission places increased pressure on beds adding to the already well publicised delays and cancelled procedures. Sterile Single-use instruments are particularly appropriate for the most difficult to clean items in order to reduce the risk to patients.
This message is largely understood and has resulted in the rapid expansion of Single-use. However there are still difficult to clean items such as Zoellner Fine Ends, and Tibbs Cannula in use in many locations despite the recommendations of national competent authorities.
There are other instrument risks that need to be recognised such as health and safety concerns for patients and clinical staff where Sterile Single-use instruments provide other benefits. For instance, Dental Syringes that minimise needle stick injury in busy gynaecology clinics because staff can dispose of the whole device in the sharps bin without further handling.
In the case of electrosurgery, the risk to patient or clinician from unwanted burns or shocks warrants additional consideration. Reusable devices inevitably suffer from damaged insulation to the instrument or cables from repeated reprocessing that places extra risks on the procedure. Sterile Single-use Bipolar Forceps and Cables overcome this problem and provide good high quality tips that remove the need for reprocessing. In colposcopy where electrosurgery is commonplace, the Insulated Cusco Speculum with Smoke Tube is a prime example of a device that must be Single-use to minimise the risks.
Thinking about the 4 R’s
This article has demonstrated that the benefits of using Sterile Single-use surgical instruments is much wider than that of only “difficult to clean” instruments. There are opportunities to deliver benefits of improved service delivery, patient waiting times and clinical pressures, all of which are highly desirable in the current environment.
The 4 R’s deliver Time, Life and Cost benefits and this will continue to drive the movement to a wider adoption of Sterile Single-use surgical instruments.