The Best Metals and Materials for Surgical Instruments

Today’s high quality surgical instruments employ a wide range of metals and materials to ensure the very highest levels of performance.

In fact, there are now so many materials in use to provide you with state-of-the-art instrumentation that it can be confusing as to which ones to opt for.

Here’s a quick look at how some of these can benefit you:

1. Surgical grade stainless steel

Stainless steel has been the metal of choice for surgical instruments for decades, not only due to its strength and corrosion-resistance, but also because it is easy to clean, making it ideal for environments where hygiene is a priority.

All stainless steel is an alloy of Iron with Carbon, Silicon, Manganese and Chromium. The Chromium produces a thin layer of oxide on the surface of the steel, which provides corrosion-resistance on the surface.

Surgical grade stainless steel has a content of at least 13% Chromium. It can also contain other chemical elements, such as Nickel and Molybdenum, which give each instrument its unique properties.

For example, Molybdenum can be added to enhance corrosion resistance, whilst Nickel is often added to reduce brittleness.

In some instances however, stainless steel surgical instruments will be made without Nickel, as it can trigger a patient’s immune system or cause an allergic reaction.

2. Ceramic

Some manufacturers of surgical instruments also offer stainless steel ranges that are ceramic-coated to provide a longer working life.

This is because ceramic coating provides four to five times higher surface hardness than stainless steel, as well as offering greater resistance to rust and corrosion.

It also gives higher sliding capability than stainless steel, minimising abrasion. In addition, a dark colour ceramic coating can minimise reflections on the surface of the instrument, which can be important in certain procedures.

3. Tungsten carbide

Surgical instruments made of Tungsten Carbide are stronger than stainless steel and can last up to five times longer.

Not only do Tungsten Carbide blades stay sharper for longer, any surgical instrument which has Tungsten Carbide in the tip, such as forceps, will be able to deliver a stronger grip.

4. Titanium

Titanium surgical instruments are the ideal choice for surgeons using magnetic resonance imaging or MRI, as they a 100% anti-magnetic.

As Titanium is also very light, it is perfect for surgeons looking to do precise, complex work without fatigue.

In addition, Titanium is fracture-proof, non-rusting and completely resistant to organic and industrial chemicals, allowing for greater durability and longevity.


Polyetheretherketone, or PEEK, was originally developed in the late 1970s by the US aerospace industry.

As it is radiolucent (transparent to x-rays), 3D-navigable and does not produce any image artefacts, it can have clear advantages when used for certain instruments, such as retractors and valves made for cervical access to the spinal column.

Being a lightweight material, PEEK can be used to create instruments that provide better handling, whilst its biocompatible properties reduces the risk of allergic reactions in high risk patients.

6. Nitinol

Instruments made of Nitinol are very useful when you need an instrument with shape memory, high elasticity, high biocompatibility and MRI compatibility.

This is because Nitinol is a metal alloy of Nickel and Titanium, which exhibits exceptional elasticity under stress.

Examples of Nitinol instruments with original shape memory include suction cannulas, vascular dilators, spatulas and clip applying forceps. These can be bent to the required shape by applying gentle pressure. They will then return to their original shape when exposed to higher temperatures, for example when autoclaving.

Instruments with super-elastic features, such as fat retractors, also adapt to the external pressure. However, as soon as this pressure is released, the instruments return to their original condition.

Not sure which surgical instruments are best for your needs?

For more information of which instruments could be right for your own needs, call our surgical instruments team on 0845 226 0185.

Surgical Instrument Discolouration Guide

What is Causing your Instrument Discolouration?


Typical causes:
Lime deposits in water
Slow/bad drying process
Substances in chemicals


Typical causes:
Blood debris
Mixing stainless and plated steel
Water with high iron content
Materials in new systems


Typical causes:
Exposure to too high a temperature (>200 C)
Being sharpened or polished incorrectly


Typical causes:
Amines after de-calcification

N20 exposure risks to liver & kidneys

Hospital employees working in areas where nitrous oxide is used to help relieve patient pain could be at risk of developing renal or liver disease, according to some studies.

An odourless and colourless gas, Nitrous oxide is a powerful analgesic in sub-anaesthetic concentrations.

Most commonly used as a 50:50 mix with oxygen, it is commonly known as Entonox.

Although the patient inhales the N20 through a demand valve, when they breathe out some of the nitrous oxide is released back into the room. This can put care staff at risk of prolonged exposure, especially in poorly ventilated rooms.

Effects of N2O on liver and kidneys

Whilst some studies have found an increased risk of liver and kidney disease in medical personnel, these findings have not been consistent across all studies.

For example, whilst retrospective cohort studies ASA 1974, Cohen et al. 1975, 1980, Spence and Knill-Jones 1978 found an increased risk of liver disease and another study, ASA 1974, Cohen et al. 1980, found an increased risk of kidney disease in women only, other studies by Lauwerys et al. 1981 and Lew 1979 found no increased risk.

So whilst there is no need to panic about these risks to staff when working with N20, it is important that you put in place measures to minimise the risk of them suffering these diseases due to their working environment.

Protecting staff from N2O exposure

The best way to ensure that you do not run the risk of your staff being exposed to hazardous levels of Nitrous Oxide is to carry out workplace exposure monitoring.

This will enable you to comply with the Control of Substances Hazardous to Health regulations which require you to monitor and record staff exposure to Nitrous Oxide against Workplace Exposure Limits set out by the Health & Safety Commission.

Workplace exposure monitoring can be implemented easily by attaching a personal sampling tube attached to employee clothing close to their breathing zone for the duration of a shift. This tube can then be analysed and a report produced from the findings.

If dangerous levels of exposure are detected, you can then tackle this problem and bring exposure levels down to permissible levels.

Of course, as well as investing in personal sampling, you should also carry out good housekeeping on an ongoing basis. Make sure Entonox equipment is well-maintained to help prevent the risk of leaks and ensure that any ventilation or scavenging systems are functioning properly.

For information on Cairn Technology’s personal sampling service for Nitrous Oxide just click here or call 0845 226 0185 and ask for our workplace monitoring team or email them at

Why Buying the Best Surgical Instruments Can Save You Money

It might sound counterintuitive: How can an instrument that costs you several hundred pounds save you money compared to lower quality instruments that you can buy for a fraction of the price?

Below are four clear reasons why:

1.       Longevity

High quality surgical instruments are always manufactured with longevity in mind. Crafted by experts in instrument design and metallurgy, they understand how to create surgical tools that optimise performance and durability.

For example, top manufacturers will always choose the highest quality stainless steel rather than lower grade metal, as this will significantly enhance instrument longevity.

They are also likely to produce ceramic-coated instruments, which provide four to five times higher surface hardness than stainless steel, reduced abrasiveness and greater resistance to rust and corrosion.

They might also make instruments in Titanium, which is another high-performance metal that is recognised for its superior durability, being both fracture-proof and non-rusting.

What’s more, instruments that are hand-crafted, rather than made by machine, can have incredibly long life expectancy.

For example, in a study to test whether Stille hand-crafted surgical scissors really did deliver on the manufacturer warranty of 30 years, it was found that 74% of the Stille scissors used in a busy surgical centre were actually older than 50 years.(1)

2.       Cost-in-Use

Of course, whilst top surgeons and the sterilization services team might well value long-lasting surgical instruments, procurement teams charged with reducing operating room costs might find it hard to justify larger upfront costs for buying these products.

This is where a lifetime warranty comparison can really shine a light on the value of investing in higher quality instruments. By simply comparing the length of instrument warranties and dividing those time periods either by instrument cost or instrument use, it can be easily seen that the highest quality instruments will always be the star performers when it comes to value for money.

Obviously, high quality instruments with the longest warranties will prove the most cost-effective, so whichever instrument you are looking to purchase, make sure to research the various manufacturer warranties before buying anything. Whilst some will offer a 30-year warranty, others may only offer 1-5 years.

Alternatively, if your procurement team is considering single-use disposable instruments, a cost-in-use comparison with a high quality reusable instrument will invariably show the latter to be the most cost-effective investment.

For example, one study of laparoscopic instruments showed that “the total cost for single-use instruments would have been more than seven times that for reusable instruments.”(2)

3.       Minimal servicing costs

Another cost advantage to purchasing high quality surgical instruments is that they will often only need servicing every couple of years and some brands even offer the first service free within the initial purchase price.

What’s more, some high-quality instruments will be designed to allow for the instrument parts to be dismantled during servicing by the manufacturer, allowing for thorough inspection of corrosion at the joints to help maximise instrument longevity.

Low-quality instruments will not only require servicing more regularly, causing greater cost and disruption to instrument availability, they are also more likely to develop hairline fractures and corroded surfaces that mean effective servicing is no longer possible.

4.       Less environmental cost

There is also an environmental cost benefit for choosing long-lasting quality instruments over cheaper reusables in many cases.

For example, a study that compared mainly German brand reusable scissors to both German and Pakistani disposable scissors revealed that the reusable scissors were better for the environment. (3)

This is because whilst they take more energy to come to market, the reusable scissors are used thousands of times more than the disposable ones.

In addition, there is less ongoing environmental impact from servicing high-quality reusable surgical instruments than low-quality ones, which will require much more documentation, packaging, labelling and transportation for servicing.

Hold out for high quality

As can be seen from the above, it is easy to justify the greater outlay for purchasing high-quality reusable surgical instruments, even in the face of significant budgetary pressures.

In fact, the rapidity with which poor quality instruments degrade means that, even if you have missed the boat for submitting instrument requests for this financial year, it is worth waiting until you have the budget to buy the best in twelve months’ time.

To view our range of high-quality surgical instruments.

You can also contact our Cairn instrument team on 0845 226 0185 to arrange for a demonstration of our surgical instruments or to evaluate instruments on loan.


(1) Dahl G, Ölveback T, Wiklung L. Quality surgical instruments best investment. Presented: SEORNA, Swedish Operating Nurse Association Conference Meeting, 29-30 November 2012

(2) Gabriel N Schaer, MD, Ossi R Koechli, MD and Urs Haller, MD. Single-use versus reusable laparoscopic surgical instruments: A comparative cost analysis. American Journal of Obstetrics & Gynecology Volume 173, Issue 6, Pages 1812-1815, December 1995

(3) 982_JGARG-Review_1-2012_Scissors_Aug2012_7g0i26.pdf

Titanium micro instruments benefits

Titanium micro instruments offer several clear benefits for the surgeon over standard stainless steel models.

For this reason, Swedish surgical instrument manufacturer, Stille, has introduced a range of titanium micro forceps and needle holders.

Designed for surgeons specialising in plastic, ENT, reconstructive or replantation surgery, they offer the following benefits:

·         They are lighter than stainless steel micro instruments, helping to reduce fatigue during lengthy procedures

·         They are made from the finest U.S. origin alloy, giving you better durability and fracture toughness than lower grade titanium instruments

·         As titanium is a non-magnetic metal, the instruments minimise frustration caused by magnetized needles

·         With the exception of the DeBakey models, the forceps and needle holders have Diamond Jaws for improved durability and proper gripping of fine sutures

·         They are very resistant to corrosion, meaning they can maintain their performance and integrity for longer

With a range of 17 titanium micro forceps and 21 titanium micro needle holders, the surgeon has a wide selection of straight and curved models to choose from.

These include micro forceps with a variety of features including tying platform, counter-balanced design, fine ring tips and 1.2mm fine atraumatic DeBakey tips.

The micro needle holder range includes models with fine 0.8mm Diamond Jaws, a regular box lock for sutures 7-0 and smaller, and optional ratchet. There is also a range with 1.2mm Diamond Jaws, a streamlined box lock for sutures 5-0 and smaller, and optional ratchet.


The above features offer clear benefits for helping surgeons during delicate and complex procedures.

What’s more, they also provide an excellent long-term investment, where the procurement department needs to be reassured that any upfront cost can be justified by instrument longevity.

If you would like to handle our Stille titanium micro instruments to see how they feel, please contact our surgical instrument sales team on 0845 226 0185. They will be happy to visit you and show you our range.

If you prefer, they can also show you our range of Stainless stainless steel micro instruments.

Surgical instrument care and protection

At first, it might seem strange that instruments made from stainless steel can suddenly appear stained or discoloured. After all, stainless steel is surely exactly that: stain-less. Well, not quite.

Stains on stainless steel

Stainless steel is stain resistant, but it is not stain-proof. That said, it is still an amazing metal with the ability to develop its own protective outer layer, known as the passive layer.

Stainless steel passive layer

This protective passive layer naturally protects against corrosion and forms when the newly made stainless steel surgical instruments are first exposed to air and the chromium and iron in the metal become oxidized.

Adding chromium to stainless steel

The natural passive layer of the stainless steel can be made thicker by treating instrument parts with chemicals that remove some of the iron but leave the chromium behind; a process called chromium enrichment.

Amazingly, if scratched, the passive layer can effectively heal itself, so long as the damaged area is left exposed to air. However, this will not happen if the scratch is covered by soil or attacked by aggressive chemicals. If this happens then stains, spots and even corrosion can start to occur.

How to care for surgical instruments and avoid damage

The key is to be aware of how to avoid damage to the passive layer in the first place, so here are a few important risks to watch out for:

  1. Soil residues – if a scratch is covered with soil residue it is not exposed to air and so cannot ‘heal’ naturally. As such, you should make sure all soil residue is removed as quickly as possible.
  2. Hard water deposits – hard water deposits such as limescale can trap other harmful water chemicals, which can lead to corrosion. To avoid this, use detergents that are designed for use with hard water and make sure you rinse the instruments in deionized or softened water.
  3. Harsh or inappropriate cleaners – a scratched passive layer can begin to corrode if exposed to harsh chemicals. Highly acidic and highly alkaline cleaners can also erode and thin the passive layer.
  4. Misuse of recommended disinfectants – always follow the label instructions on any disinfectants you use both in terms of concentration and exposure times.
  5. Exposure to chlorine – care needs to be taken with chlorine-based disinfectants, as they can be highly corrosive due to high oxidation potential. Hypochlorous acid can damage even stainless steel, causing discoloration and pitting. Stainless steel instruments should never be soaked in chlorine solutions as this can ruin sharp edges and pit the instrument surface.

Residue in reusable instrument wraps – if an alkaline or acidic residue is left in instrument wraps after cleaning, this can transfer onto the instruments, causing them to become stained and corroded. As such, the cleaning process should be checked to ensure all residue is removed.

Flash sterilization – this should only be used in exceptional circumstances as rapid temperature changes can also damage the passive layer.

Ammonia/amines – if these are present they can cause a purplish black stain. If this happens, clean the autoclave steam lines as per sterilizer instructions.

How to identify the cause of staining and corrosion

In many cases, as with ammonia, the distinctive colour of the stains on an instrument can be a strong indicator as to what is causing the discolouration. This can help to quickly identify the problem and avoid further staining and corrosion. To help you do this, just see our infographic which links specific colours to possible causes.

Controlling the Spread of the Wuhan Novel Coronavirus

As the number of deaths caused by the Wuhan novel coronavirus (WN-CoV) continues to rise, more and more measures are being taken to try and control its spread.

According to the BBC News website, not only have 132 people died from the virus in China, there have now also been reported cases of it in 16 other countries.

The new virus was identified by Chinese authorities on 7th January. According to the World Health Organization, it was of immediate concern because as it was not known how it would affect people.

Temporarily named “2019-nCoV” and now referred to as WN-CoV, the virus is part of the family or coronaviruses. This family includes the common cold, as well as viruses such as SARS, which infected thousands of people between 2002 and 2004 and claimed 774 lives.

Whilst there is no specific cure or vaccine for Wuhan novel coronavirus, the UK government has only just made the decision to start quarantining people coming to Britain from Wuhan.

Fortunately, according to the Department of Health, of the 97 people already tested for coronavirus in the UK all have been confirmed negative. However, it is still possible that people with the virus may present themselves at hospital A&E departments or doctors’ surgeries over the coming weeks.

So how can hospitals tackle the spread of WN-Cov?

Public Health England has put together comprehensive guidance for healthcare professionals and facilities that may be involved in the investigation or management and care of possible cases. Just click here to see this coronavirus infection prevention and control advice.

Covering everything from patient isolation to environmental decontamination, waste disposal and more, this guide is packed with useful advice for protecting patients, staff and visitors.

For example, it advises that “After cleaning [patient rooms/environments] with neutral detergent, a chlorine-based disinfectant should be used, in the form of a solution at a minimum strength of 1,000ppm available chlorine.”

You might also want to try using Virusolve+. This high level cleaner and disinfectant has been proven in an independent EN14476 test to be effective against Feline Coronavirus (human surrogate for SARS).

Whilst it has obviously not yet been possible to test its effectiveness against WN-CoV, at least it has already been shown to be effective against another dangerous virus in the coronavirus family.

If you are interested in finding out more about Virusolve+.

Allaying public concerns about Wuhan novel coronavirus

You can also help members of the public that visit your hospital or surgery by directing them to useful online advice from the World Health Organization at this link:

It has some great tips on hand hygiene and how to stay safe when out and about or travelling.