The Operating Theatre Journal Digital Edition November 2018

Why poor quality
surgical 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 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
Low 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 Swiss 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.
Article author Michael Ray,
Area Account Manager, Cairn
Technology Ltd.
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?
Congratulations, reading the extended OTJ
You can 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.
When responding to articles please quote ‘OTJ’
The next issue copy deadline, Friday 23rd November 2018
All enquiries: To the editorial team, The OTJ Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YY
Tel: 02921 680068 Email: admin@lawrand.com Website: www.lawrand.com
The Operating Theatre Journal is published twelve times per year. Available in electronic format from the website, www.otjonline.com
and in hard copy to hospitals throughout the United Kingdom. Personal copies are available by nominal subscription.
Neither the Editor or Directors of Lawrand Ltd are in any way responsible for the statements made or views expressed by the contributors.
All communications in respect of advertising quotations, obtaining a rate card and supplying all editorial communications and pictures to the Editor
at the PO Box address above. No part of this journal may be reproduced without prior permission from Lawrand Ltd. © 2018
Operating Theatre Journal is printed on paper sourced from Forest Stewardship Council (FSC) approved paper mills and is printed with vegetable based inks. All paper and ink waste is recycled.
Journal Printers: The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD
4 THE OPERATING THEATRE JOURNAL www.otjonline.com