AS I SEE IT


Presterilizing Versus Re-Sterilizing Implants and Instruments Considerations for ASCs, insurers, surgeons and patients BY JOHN WELLS


While single-use equip- ment is not new in health care, the kinds of instru- ments and related devices going the route of “one and


done” are changing. More and more surgical centers and


surgeons worldwide are asking whether presterilized, single-use instruments and implant-related devices have dis- tinct advantages over those that are repeatedly sterilized.


In orthopedics, presterilized surgical kits that supply only the implants—such as screws and plates—and accompany- ing instruments necessary for specific procedures are gaining traction. Ortho- pedic units in Scotland converted to single-use, presterilized and individu- ally wrapped plates and screws in 2008. In its advance notice to medical prac- tices (http://www.sehd.scot.nhs.uk/cmo/ CMO(2006)13.pdf), the Scottish Execu- tive Health Department stated, “Repro- cessed steel implants can cause inflam- matory reactions to a much greater degree than pristine devices. . . . There are also issues of corrosion and weak- ening caused by repeated processing.” Presterilized implants and instru- ments are already widely used in spine surgery in the US. The typical drivers behind single- use equipment also are at work here: ■■


increasing financial constraints fac- ing providers and insurers;


■■ ■■


reducing risk of surgical site infec- tions (SSI); and


greater operating room efficiencies. Presterilized trays—that contain sur- gical instruments only—also are gaining popularity at ASCs. ASCs find greater efficiencies with presterilized instru- ments. They allow more procedures to be performed with shorter turnover


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time, take less room to store, are easily received into inventory by staff, and can be supplied at similar cost to traditional implants and instruments that require processing and sterilization.


Interoperability Advantages Seldom does a surgeon enter an oper- ating room (OR) without a clear idea on how to treat the patient. They do, however, prefer to have the flexibil- ity to choose the right device in those cases where, once the surgery is under- way, they can fully assess the situation and change the direction of treatment if necessary.


ASC FOCUS JUNE/JULY 2018 |www.ascfocus.org


In terms of using instrument trays


that have been sterilized on-site, doc- tors and nurses might be presented with multiple large trays with an array of plates, screws and various other tools. Too much choice crowds case carts and back tables; plus, the potential for con- tamination is a concern with wrapped trays, which contain sterilized instru- ments wrapped with a sterilized cloth. In contrast, presterilized instrument kits are a quarter of the size of regular trays and the surgical team uses only what is needed, cutting down on waste and minimizing contamination risk,


The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.


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