Poor quality instruments put patients at risk

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Fears that contaminated surgical instruments are causing unnecessary illness and deaths because of the risk of infection continue to hit the headlines.

From Alzheimer’s proteins to HIV, Hepatitis B or C and many more dangerous diseases, there seems to be a steady stream of stories about how patients’ health has been put at risk.

What is not often mentioned in conjunction with these stories however, is the fact that poor quality surgical instruments are often to blame for poor standards of infection control.

What’s more, despite a BBC documentary “Surgery’s Dirty Secrets” revealing several years ago that large numbers of surgical tools used in the NHS failed to meet quality standards, the problem of poor quality instruments is still rife.

In fact, Tom Brophy, a lead technologist with Barts Health NHS Trust went on record at the time to say that about 20% of all the instruments that he received were rejected because of flaws that could put patient’s health at risk.

So why do poor quality surgical instruments pose a risk?

Poorly manufactured surgical instruments can risk patient health for a number of reasons:

·         Micro-punctures in surgeons’ gloves

Poor quality surgical instruments are often machine-made and finished, leaving metal fragments and sharp burs that can lacerate surgical gloves.

As these punctures can be miniscule, they can easily go undetected during a surgical procedure, creating an easy pathway for infection to be transferred to the patient.

·         Defects that are invisible to the naked eye

In addition to revealing sharp burs and microscopic shards of steel, an inspection of a poor-quality instrument under a microscope will often reveal numerous other defects that can pose a risk to patients.

This is because by using low-grade steel, such instruments can easily become corroded or pitted and even develop hairline fractures.

This means that whilst an instrument might seem perfectly clean to the naked eye, a look under a microscope can reveal numerous areas that could be harbouring dangerous bacteria and viruses.

·         Unclean manufacturing facilities

Although Swedish craftsmanship and German-quality stainless steel may come to mind when one thinks of surgical instruments, two-thirds of the world’s instruments are actually made in Pakistan.

While some of these manufacturers adhere to high standards of manufacture, others have been found to operate in dust-filled environments near to open sewers, piling newly made instruments on the floor and failing even to carry out a visual inspection with a magnifying glass before marking their wares with a CE quality stamp.

Clearly this then begs the question just how clean these brand-new instruments are by the time they get into the hands of our UK surgeons.

·         Low grade materials

It is clear to see why both UK surgeons and NHS procurement teams would want to avoid poor quality instruments that pose such risks of infection and harm, even when the pricing can differ so significantly between high-quality and poor-quality instruments.

Of course, German stainless steel is recognised as the very best material for making surgical instruments, but in a time of ongoing budgetary pressures on the NHS, surely it makes sense to buy less expensive ‘German’ instruments than recognised brands?

However, due diligence is needed here as well, as the ‘Dirty Secrets’ documentary also revealed Pakistani representatives offering to sell tools made with Pakistani and French steel that are stamped “Made in Germany”.

The result is that hospitals may still end up paying a lot for substandard instruments that pose a risk to hygiene and health.

·         Design limitations that affect cleanliness

Another issue with poorly manufactured surgical instruments is that they have not been designed to be dismantled for cleaning and inspection.

As infection is harder to eradicate around instrument joints, being able to fully separate parts can significantly reduce the risk of cleaned instruments continuing to harbour germs.

LOOKING FOR HIGH QUALITY SURGICAL INSTRUMENTS?

Why not browse our range of Stille and Lawton quality surgical instruments by clicking here?

You can also contact the Cairn instrument team on 0845 226 0185 to discuss individual instruments, recommended instrument sets or to arrange for a demonstration of specific instruments.

Surgical Instrument Care Infographic

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Micro Surgery Instruments: Micro Scissors, Forceps & Needle Holder Technology

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When it comes to selecting micro instruments for your next instrument set, you can rest assured that there are some exceptional products on the market.

In this article, we look at a number of materials and design features that are enabling cutting-edge instrument performance in the field of micro surgery.

Micro Scissors Innovations Making the Cut

German Surgical instrument manufacturer, Lawton, has developed a wide range of micro-scissors with flat spring or round spring type handles that incorporate a number of innovative design features.

In addition to stainless steel, they can be made from titanium. This non-magnetic material allows for use during MRI and minimises the inconvenience of magnetised needles during procedures.

Fracture-proof and corrosion resistant, titanium is stronger and more durable that stainless steel, whilst its lightness facilitates precise working without fatigue.

Lawton has also developed a number of stainless steel and Titanium models with a ceramic coating to provide a much harder instrument surface and higher sliding capability.

In addition, some of Lawton’s micro scissors with flat spring handles offer increased sliding capability due to a streamlined design at the joint.

Whilst some of Lawton’s round spring handled models come with a lightweight handle with special cavities to enable fatigue-proof working.

Swedish instrument manufacturer, Stille, has also been expanding its line of micro instruments to include new titanium patterns. Its micro scissors are the only ones on the market with Supercut scissor blades: one knife blade and one scissor blade providing precise cutting to the very tip.

The innovative joint screw design also allows for easy removal for instrument servicing.

If you would like a demonstration of any of these micro scissors contact our surgical instrument team now on 0333 015 4345 or email info@cairntechnology.com.

Get a Grip of these Advances in Micro Forceps

If you are looking for micro forceps with greater durability than stainless steel and improved gripping of fine sutures, then Stille’s titanium Diamond Jaws models are definitely worth trying out.

Lawton has also enhanced the performance of micro forceps with its PERFECT-GRIP jaws, which are specially coated to ensure a gentle, non-slip grasping of vessels, tissues, needles and sutures.

Some of their round spring typed handled forceps also incorporate a lightweight handle with special cavities to enable fatigue-proof working.

If you are interested in comparing the look and feel of these micro forceps, call our surgical instrument team now on 0333 015 4345 or email info@cairntechnology.com.

Micro Needle Holders to Keep an Eye On

Again incorporating Diamond Jaws for greater durability and enhanced gripping capability, Stille’s micro needle holders are designed to hold the finest sutures in a tight and secure grip. For heavier models, the use of tungsten carbide inserts allows for an even stronger grip.

Lawton’s range of micro needle holders also incorporates a number of features to optimise performance during surgery. From titanium and ceramic coated instruments giving enhanced durability and improved sliding capability, through to PERFECT-GRIP jaws and a lightweight handle design, Lawton’s range is packed with features to accommodate every micro surgeon’s preferences and needs.

If you would like a demonstration of any Stille or Lawton micro needle holders, please contact our surgical instrument team now on 0333 015 4345 or email info@cairntechnology.com.

More Information on Micro Instruments

If you would like more information on our titanium micro instruments. You can also contact us to arrange an appointment to see or trial our micro instruments. Just call us on 0333 015 4345.

Are Stille SuperCut Scissors Really a Cut Above the Rest?

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If you are a surgeon with an eye for excellent surgical instruments, you may have noticed that SuperCut-type scissors are no longer made exclusively by Stille, except when it comes to micro scissors.

This is despite the fact that the Swedish instrument company actually invented and launched the original SuperCut scissors in 1982.

However, despite there now being other makes of SuperCuts on the market, several independent studies have shown that Stille SuperCuts are continuing to outperform other brands. In fact, the findings might surprise you.

So what’s so good about Stille’s SuperCuts?

There are four key areas that set Stille SuperCut scissors above other brands:

1. Unique design for cutting

Designed for cutting all types of soft tissue, Stille’s SuperCut scissors have two cutting surfaces that are sharp to the very tip and work together in a unique way.

That is because one cutting surface is a scissor blade and one is a knife blade. This means that the surgeon can use the scissors to cut with extreme precision, relying on an instrument that combines maximum cutting power with minimal force to produce the perfect cut.

All other brands of so-called ‘SuperCut’ scissors are made differently from Stille, usually with serrations on one blade that are allegedly designed to grip tissue. However, due to the way that Stille handcrafts its SuperCut scissors, they are actually much sharper than other brands of ‘SuperCut’ scissors.

2. Ergonomic, ambidextrous design

Stille has also put a lot of thought into the design and ergonomics of their SuperCut scissors to create a light but balanced instrument that minimises fatigue and maximises efficiency.

With smooth finger rings, shanks designed for feeling and balance and a strong screw joint for maintaining the correct tension between blades, the scissors provide the surgeon with a smooth fingertip feeling.

The scissors are also flexible for the needs of different surgeons. For example, due to the way in which the scissors are sharpened, they can be used by both left and right-handed surgeons.

What’s more, the scissors have larger finger rings than some other brands, which is useful for surgeons with larger hands or those that use a double glove technique.

3. A removable screw for effective servicing

Another unique feature of Stille’s SuperCut Scissors compared to other brands is that its joint screw can be removed by Stille’s technicians during servicing to inspect for corrosion.

Other SuperCut brands do not have this capability, meaning that both the cleanliness and longevity of these instruments can be compromised.

This was supported by a study(1)that compared two German brands of scissors with Stille scissors. The study found that only Stille’s scissors had a screw that could be removed during servicing; it was also the only scissor with no signs of corrosion under the joint.

What’s more, the removable screw design ensures that the SuperCut scissors can be sharpened back to their original condition by Stille’s expert craftsmen during servicing. This is because large amounts of blade material do not need to be ground away, something that would inevitably change the shape and size of the blades until they are no longer close enough for a good cut.

In addition, by removing the screw during servicing, the surface of the blades can be fully resurfaced, removing any crevices where pockets of dirt may hide.

4. An outstanding 30-year warranty

Unlike other brands, Stille guarantees that their SuperCut scissors will last for 30 years, providing that they are handled and sterilised correctly and that Stille’s own expert craftsmen carry out any servicing.

In fact, Stille offer the first service for free, which is typically required after three years of use, although the surgeon decides when his or her instruments are ready for servicing.

Whilst a 30-year warranty might sound very long, date codes on Stille instruments returned for servicing often show that they have been in regular hospital use for more than 40 years.

This was also shown to be the case in an independent study to test whether Stille hand-crafted surgical scissors really did deliver on the manufacturer warranty of 30 years. In fact, the study found that 74% of the Stille scissors used in a busy surgical centre were actually over 50 years old.(2)

Want to see Stille SuperCut scissors in action?

If you would like to find out more about our Stille SuperCut scissors just click here (Link to new SuperCut Scissors section on website).

You can also contact our Cairn instrument team on 0845 226 0185 to arrange for a demonstration of our Stille SuperCut scissors or to evaluate an instrument on loan.

REFERENCES:

(1) Anette Karppinen, ORN, Access to crevices critical for surgical instrument safety. Presented SEORNA, Swedish Operating Nurse Association, Conference Meeting, 29-30 November 2012. http://www.stille.se/files/studies/whitepaper_instrument_safety.pdf

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

The Best Metals and Materials for Surgical Instruments

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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.

5. PEEK

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

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What is Causing your Instrument Discolouration?

Light/Dark

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

Rusty

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

Brown

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

Purple/Red/Black

Typical causes:
Ammonia
Amines after de-calcification

Why Buying the Best Surgical Instruments Can Save You Money

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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.

REFERENCES:

(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) http://www.sustainable-manufacturing.com/files/ 982_JGARG-Review_1-2012_Scissors_Aug2012_7g0i26.pdf

Titanium micro instruments benefits

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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.

WANT TO HANDLE OUR TITANIUM MICRO INSTRUMENTS?

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

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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.