The Clinical and Economic Case for Sterile, Disposable Instruments and Implants

Contamination incidents related to cannulated endoscopes has caused more scrutiny of re-sterilization and re-use of orthopedic instruments. This article reviews instrument re-use vs. a trend in foot/ankle surgery toward sterile/disposable sets. We conducted a survey of operating room nurses to consider their current practices and the economics/efficiencies of in-hospital sterilization and disposable orthopedic instruments. Of the 100 respondents, 60 percent had been in the profession for more than 12 years, 20 percent for 8 to 11 years, and 20 percent for four to seven years. When asked how long it took to process and sterilize an instrument set at their facility, 83 percent of respondents said >61 minutes and 10 percent said 31 to 60 minutes. The most worrisome finding was that a majority had seen material residue on cannulated implants or instruments in the OR. Forty-seven percent of respondents estimated the per-case cost of instrument processing to be $600 to $1,000; with 30 percent estimating a lower cost and 23 percent a higher cost. By contrast, single-use disposable instruments can save more than $400 per case by reducing hospital labor and sterilization costs. Disposable instruments can also lower upfront and replacement cost, stand up to the rigors of surgery, help prevent expensive surgical site infections, and reduce liability risks.