If there’s one thing everyone agrees on, it’s that the debate around reusable vs disposable surgical instruments is complex. As we work with many Australian hospitals, here is what they are telling us they use to weigh up the pros and cons.
Degree of infection control required
An article in Infection Control Today says that one of the critical steps is to determine the level of infection control needed. At the top are items that must be sterile before entering sterile tissue, such as surgical instruments. At the bottom are non-critical items such as stethoscopes that only come in contact with intact skin and are least likely to transmit disease.
There are numerous ways that errors can slip into the sterilisation process. An SA Health spokesperson is quoted as saying: "Using SUDs may reduce the risk of health-care acquired infection for patients arising from human error in cleaning and sterilisation, with some devices extremely difficult to clean adequately. Reprocessing of commonly used items such as suture scissors and scalpels is also time-consuming and can delay timely patient care."
Time: Surgery delays and instrument reliability
Especially for smaller hospitals with limited or outsourced CSSD capabilities, or larger hospitals with a stretched CSSD – it can make practical sense to lower the number of instruments requiring reprocessing. This can limit surgery delays or hold-ups due to missing instruments and reduce the load when the CSSD is stretched. Elite Medical’s Adrian May said that disposables are especially suited to operating theatres doing high numbers of short procedures. “If an OR does 10-15 procedures per day, they either need to keep enough stock to handle an entire day, or wait for turnaround from the CSSD,” he said. “Disposables can sometimes free up enough time to squeeze in an extra procedure or two, which makes the ROI argument very clear.”
How many times can an instrument be reprocessed without compromising reliability? This is up for debate. One article stated: “Device reprocessing has repeatedly been linked to residual contamination left by reprocessing agents that fail to enter difficult-to-reach areas of reusable devices, as well as breakdown of device materials resulting in often imperceptible damaged areas that serve as breeding grounds for infection and may, over time, compromise functionality of the device. Reprocessing may also expose healthcare workers and patients to toxic chemicals and results in an unsafe devices when the manufacturer’s instructions for use (IFUs) are inadequate.”
The cost vs risk ledger
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Disposable |
Reusable |
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Upfront cost |
Upfront cost |
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Storage
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Reprocessing – labour, equipment chemicals, testing, maintenance, repair, reworking |
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Waste disposal – financial/environmental cost |
Increased infections – readmission, increased hospital stays, reputational damage |
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Productivity – surgery delays due to processing delays or missing/damaged instruments |
Costs and risk tolerance will vary from hospital to hospital and it’s important to draw conclusions based on your specific circumstances. As this article states: “One study analyzing the cost and operational performance of disposable versus reusable forceps calculated the total cost per use of the disposable forceps as $38 and as $415 for the reusable forceps. The authors of the study also pointed out that the likelihood of the reusable forceps malfunctioning at 11 to 15 uses was 5 percent; at 16 to 20 uses the likelihood increased to 25 percent; and at 21 to 25 uses reached 80 percent. In addition, when the reusable forceps were dismantled at the end of the study, the device was found to have coiled sheath kinking, rust in the closure mechanism, bent spikes and biomaterial contamination.”
Adrian May from Elite Medical said that it is always worth doing a price comparison because disposable costs have come down in the last decade and preconceived ideas about the cost differential are worth revisiting on a regular basis.
“There are some disposable products with a crystal clear cost benefit,” he said. “Our disposable non-stick bayonets are around 10 times cheaper than reusable tips. We’ve had scepticism from hospitals saying the disposables seem too cheap, and then feedback from surgeons that they are a superior product.”
When it comes to environmental considerations, the financial and environmental cost of waste disposal needs to be balanced with the reduced risk of cross contamination and the environmental impact of sterilisation processes. In addition, newer disposable products are being streamlined: “Our generation II forceps are made with 40% less plastic to reduce waste,” Elite Medical’s Adrian May said.