Should a sharp, fit for purpose instrument really be a luxury item?

Surgeons use tools to perform all kinds of Surgery, from Brain to Bowel to Feet. The tools they use differ, but in essence do the same thing. These tools, or instruments as they are called in the trade, essentially cut human tissue so it can be divided, removed or replaced with a prosthetic. All surgeons will use a scalpel to penetrate the skin to access whichever organ or part of the body they need to gain access to. The Scalpel is a single use instrument, sharp and disposed of almost immediately after the initial skin incision, the reasons for this are thus, a thin blade to create a clean incision will blunt very quickly, a blade used in the skin may carry Skin Flora (bacteria) which if used again within the body may transfer this bacteria inside. Most eye surgery instruments follow the same premise and are disposed after 1 use, imagine using a blunt instrument in the Eye! Laparoscopy (key hole Surgery in the Abdomen) instruments have long shafts with moving parts, which are very difficult to clean properly and guarantee all contamination has been removed. Orthopaedic instruments generally cut bone, saw blades for Knee and Hip Replacement have been around for decades but only became single use in the last ten years. A saw blade, attached to a power tool, needs to be sharp to ensure accurate cuts for fitting of a prosthesis. A blunt saw blade will have to work harder, vibrate more and ultimately transfer this vibration into the surgeons hands. Prolonged use could lead to Hand-Arm Vibration syndrome. Arthroscopy shaver blades, again Single-use, cut soft tissue and remove bone. Osteotomes and Curettes sculpt and remove bone by a more controlled fashion, they are manually held and controlled by the hands rather than attached to a mechanical device. Most of these manual instruments seem to have flown under the radar for decades, blunt, old, maltreated and rarely, if ever, sharpened are handed to Orthopaedic Surgeons on a daily basis. Some even resemble Museum pieces. Have Surgeons just accepted that this is how it is? Should it really be a luxury to use something fit for purpose?

Are Surgical Instruments as clean as we think they are?

Modern Surgical Instruments require advanced cleaning. Technological advancements in Surgery have led to more precise and narrow surgical instruments intended to minimise incisions and trauma leading to enhanced recovery times. But often, the biggest threat to a patient is the bioburden and bacteria trapped inside the instrument from a previous patient. Size variations in cannulations and working mechanisms, especially in Arthroscopic and Laporoscopic Surgery pose significant challenges for manual cleaning.

The intricate features of an instrument that enable a surgeon to perform a minimally invasive procedure cause a nightmare for Sterile Service Departments. Narrow lumens, bends, changing diameters, and other features common in modern surgical tools create barriers for manual brushing. Bioburden (including blood and other human residue) may become packed inside of instrumentation, creating a risk for infection and cross-contamination between patients. Although the instrument will be sterilized, the sterilization process is ineffective if bioburden is present.

Unclean Surgical Instruments CANNOT be sterilised.

These images show the interior lumens of surgical instrument AFTER they had been manually brushed and sterilized per the manufactures’ instructions. Often a sterile crust is formed over the live bioburden and can be peeled away or re-moistened, therefore exposing live bacteria.

As Surgical instruments become more complex they must also not forget the basics, Sterilty.

Single-use instrumentation is the only way to be 100% sure of zero cross contiminate. The results could reduce the transmission of HAIs from dirty surgical tools and save lives!