Poor quality instruments put patients at risk
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.
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