Infection prevention
Difficult to clean devices: the case for single use
Not all instruments can be guaranteed clean, especially those with narrow lumens. Jon Blastland argues that single-use alternatives could help reduce the risk of surgical site infection.
During surgery, germs can be transferred into the surgical wound through various forms of contact – including microbial flora on the skin, the surgeon’s hands, the operating theatre environment itself, or contact with a contaminated surgical instrument – leading to increased risk of surgical site infection (SSI). In England, SSIs are one of the most common healthcare-associated infections (HCAIs), accounting for around 16% of all HCAIs.1 SSIs are a major cause of increased length
of hospital stays, morbidity, and mortality. The rate of SSI also varies depending on the type of surgical procedure, with rates of less than 1% for orthopaedic procedures and rates of over 10% for large bowel surgery.2 However, as post-discharge SSI surveillance
practices vary significantly between Trusts and SSIs often present after the patient has been discharged from hospital, it is widely acknowledged that reported figures are likely to be an underestimate. For patients, an SSI may mean many months in hospital, as well as additional surgical procedures. In addition, SSIs also present a significant financial cost to the NHS. Each infection is estimated to cost just over £10,000 per person, with deep-incisional SSIs costing an astounding £100,000 per patient.3
With health systems still reeling from the effects of COVID-19 – and budgets under extreme pressures – the vital role of infection prevention in improving patient safety and outcomes has never been more prominent. Despite advances in infection control procedures, SSIs still present a significant challenge for healthcare systems across the world. This is particularly poignant given research
shows that up to 60% of SSIs are preventable..4 SSI prevention is made up of several stages, all as important as each other – from the environment in which patients are cared for, to the equipment, medications and devices they are exposed to during surgery. One of the biggest challenges is ensuring that reusable surgical instruments are effectively
sterilised to minimise the risk of infection to patients. This involves a highly strict set of standards and processes at all stages of the decontamination life cycle – with any misstep increasing the risk to patients. An important consideration is the fact that
not all instruments can be guaranteed clean. This is especially true for instruments with narrow lumens, sharp bends and rough edges. Narrow channels can be difficult to clean, and instruments can also become blunt from use or damaged – which all impact on their performance ability. In a bid to combat the high level of HCAI rates in the UK and worldwide, and to comply with Government guidelines to adopt best practices in the healthcare setting, a growing number of healthcare facilities are taking steps to evaluate and improve standards in cleanliness – and assessing the costs and benefits of alternative practices, including introducing single-use instruments to replace those that are difficult to clean for surgery.
Single-use solutions The effective decontamination of surgical instruments is essential for patient safety and to avoid unnecessary delays and inefficiencies in hospital operating theatres. High on the list of items which cause concern
to most sterilisation managers and end-users alike, are surgical instruments which are difficult to clean. This is why many hospitals around the world are increasingly recognising the benefits of switching to single-use surgical instruments, which present a safer alternative, helping hospitals reduce the risk of patient-to- patient cross-contamination, reduce time, and cut costs. The traditional alternative to single-use instruments is reusable instruments, which by their very nature carry a degree of risk for cross-contamination and surgical site infections, if not reprocessed effectively. Common errors vary – from staff not having all the manufacturer’s instructions to hand, to not following all the manufacturer’s written
February 2023 I
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