April 2009 Insert Return to Homepage

The Case for Disposable Vitreoretinal Surgical Tools

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At AIO,we use disposable instrumentation. At first glance, it may seem that when considering disposables vs reusables, reusables would make more sense for practical and economic reasons.Our decision to use DSPs was based on the fact that they offer additional value in efficiency over some of the more intangible costs of reusables.

COST CONSIDERATIONS
After doing some research, I found that at AIO, our damage ratio for reusables has been approximately 10% to 15% with a significantly higher damage rate for 25-gauge reusable instrumentation.

The initial cost of reusable instruments is also significant: the cost of a pair of reusable scissors, for example, is between $1,900 and $2,000 and multiple trays are required to keep up with our case volumes as well as providing additional back up instrumentation. 23- and 25-gauge reusable instruments are more easily damaged due to their fragility during everyday handling and wear and tear. When adding in the cost of sterilization to damage that can occur during the sterilization process, the costs continue to mount.

REPAIR ISSUES
The downtime that results from sending an instrument out for repair can have a significant impact on the efficiency of a practice, adding steps to the surgical routine that are time-consuming and hinder a smooth process and proper management of instrumentation. Additionally, instrument damage is obviously a problem that affects safety. Some of the most common damage that we see with microsurgical instrumentation is misalignment—we do not even have any 25-gauge reusable microsurgical instruments in our supply because in our experience the lives of reusable instruments in 25-gauge surgery are short.Other common damage to reusable microsurgical instruments include bent or burred tips. Also, if the instrument is serrated, it is difficult to clean and can become easily misaligned.

With disposable instrumentation, we do not have these issues—we know that every time we use an instrument, it will perform with consistent quality.

THE CLEANING AND STERILIZATION PROCESS
Another important issue related to safety is cleaning and sterilization. Our cleaning process is rather detailed and is performed in several steps. First,we rinse all of the instruments in sterile distilled water on the sterile field.Afterward, the instruments are taken to the soiled workroom and cleaned with a fine brush in soapy distilled water, rinsed and brushed again with distilled water, and then “swished” in another basin of distilled water.We then place the instruments in an ultrasonic cleaner, again using distilled water.

After this cleaning process is completed, the trays are taken to a clean workroom where they are placed in the autoclave for sterilization. If we are wrapping the instruments,we are careful to make sure that the trays and instruments are dry by using an air gun.

Carefully using this detailed and lengthy process, microinstruments can be cleaned properly and effectively, but the process is time-consuming and we have found it more efficient for our OR turnover times to use DSPs. In my opinion, the less autoclaving and sterilization that is required, the better.

SUMMARY
We reduce the risk of cross contamination by using disposables and ensure a high standard of care to every patient, while eliminating lengthy instrument reprocessing cycles.

At AIO, it is our opinion that the costs of reusables are actually higher than disposables because of damage rates, repair costs, and sterilization factors, as well as other, more intangible costs like OR waiting time while a damaged reusable instrument is being replaced or when reusable instrument tips do not meet the surgeon’s expectations for safely and efficiently performing a case.

Saralee Sable is a certified surgical technician (CST) at Associates in Ophthalmology/Associates Surgery Centers in Pittsburgh.

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