How do hospitals sterilize operating rooms

Surgical instruments Use single-use or reusable products in the clinic?

Reusable or single-use instruments in the OR? There are basically two options: using single-use items and disposing of them after use, or using reusable items that must be cleaned after use and their sterility restored. Improperly cleaned, reprocessed instruments pose a risk to the patient. Disposable instruments are sterilized and individually packaged. They are intended for single use and are then disposed of. From an ecological point of view, however, single-use instruments are extremely questionable. Waste manager medicine summarizes the advantages and disadvantages.

According to a report by the specialist magazine MedReview from 2014, around 70 percent of German clinics use reusable cutlery. According to a study by the market research institute GfK, reprocessed products are most frequently used in urology and gastroenterology. The performance of reusable and disposable products is measured using the following criteria: On the one hand, the functional performance of the products and, on the other hand, the costs.

Disposable instruments

Disposable instead of reusable: There has been a trend for scissors, tweezers and other instruments in hospitals and medical practices for several years. How much single-use cutlery is really in circulation is only an estimate. For 2014, the Fraunhofer Institute for Recycling and Resource Strategy (IWKS), which deals with recycling, assumes that 8,000 tons of single-use instruments were thrown away in hospitals in Germany alone. Manufacturing companies support these figures. “Scholz Labor- und Klinikbedarf”, one of the larger providers on the market, estimates that hospitals and medical practices now dispose of around 15 million disposable scissors, tweezers and other instruments in the clinic waste.

The disposable cutlery are usually made of steel or plastic (polymer). In particular, the steel instruments are functionally and haptically hardly distinguishable from reusable products. Metal instruments must be cleaned, washed, packed and sterilized after each use. These work steps are time-consuming and costly. With single-use products, these complex processes are completely unnecessary. Other expenses, such as for an autoclave and a film sealing device, are not required when choosing disposable products. The costs for consumables such as instrument disinfectants and sterile packaging can also be saved, as well as the personnel costs that arise when reprocessing instruments.

In addition to the economic aspects, single-use instruments have another advantage: The responsibility for sterilization lies with the manufacturer. The clinic receives a brand-new, unused instrument that is neither damaged nor soiled. In addition, there is a long shelf life and safe packaging.

Problematic with the single-use instruments: They can only be partially recycled. The instruments contain precious chromium that would practically be lost in clinical waste. In order to recycle the instruments, however, they would have to be collected separately and then given for recycling.

Reusable instruments

If reusable instruments are used in the clinic, sterile items are required. All surgical instruments, regardless of whether they were used during an operation or not, are prepared for cleaning, disinfection and sterilization and taken out of the operating room after the operation.

During operations, the instruments are completely disinfected or cleaned and sterilized before being used again. The prerequisite for this, however, is that the reprocessing can guarantee both technical-functional and hygienic safety. The cleaning and sterilization of reusable instruments and the resulting logistics processes are costly and time-consuming, which is why many companies shy away from using them.
Third-party or self-sterilization

Furthermore, the transport of unclean sterile items to the sterilization system is not free of risks, because unclean surgical utensils can pose a risk of infection. According to the technical rules for biological agents (TRBA 250), transport is generally assigned to protection level 2.

If the cutlery is to be sterilized in the clinic and the order is not to be transferred to an external company, investments in the various areas may be necessary:

  • Know-how of reprocessing and sterilization processes, especially their validation
  • Clean room technology and sterilization equipment
  • high quality instruments
  • Know-how and IT support in materials management and logistics

The greatest risk of infection arises when preparing the instruments for cleaning, as the instruments are contaminated with blood, body fluids or body tissue. Disinfection leads to a reduction in germs, so the risk after disinfection is significantly lower.

There is no risk for patients when using reusable instruments if the products are professionally reprocessed using a validated process. Hospitals can also save costs here. This is the result of the study “Reconditioning and Repair: In the Tension Between Quality Requirements and Cost Pressure” by the Ludwig Fresenius Center for Health Care Management and Regulation at the HHL Leipzig Graduate School of Management.

Experiences from practice

Roland Dittmann is the waste officer at the St. Georg Hospital in Leipzig. Here, for the sake of the environment and for cost reasons, reusable instruments are used: “We only offer disposable instruments as station ware. Reusable instruments are used in the operating theater. ”In addition, a project to examine the use of only single-use products in the wards showed that their use was too expensive. "I also cannot imagine that all instruments are available as single-use products in the same high quality," continues Dittmann.

The Federation for the Environment and Nature Conservation (BUND) welcomes it when clinics question the use of single-use products against the background of resource and environmental protection. Annegret Dickhoff, project manager for climate protection in health facilities, told waste manager medicine: “The need to use medical products once, which are made of high-quality plastics and in some cases in connection with electronic units, must be counteracted. Legislators are asked, as are clinic purchasing and the manufacturers themselves. ”From their point of view, there is already a market for sustainable solutions. “Clinics want to operate in a more climate-friendly way, as we see in the KLIK green project. This means that medical device manufacturers have good market opportunities with product solutions that, for example, offer a combination of reusable and single-use products, ”continues Dickhoff.

Multiple use of single-use instruments

Multiple use of single-use instruments should be completely ruled out. According to a report by the recycling portal, there is an increasing number of hazardous reprocessing of single-use instruments. In principle, the reprocessing of single-use instruments is permitted in Germany, unlike in Austria, for example, where they end up in the waste after a single use.

The materials of the single-use products are not suitable for the necessary alkaline cleaning. There is a risk of contact corrosion and the formation of extraneous rust. So that the cutlery does not rust during the sterilization process in the autoclave, it contains nickel. This is exactly what the disposable cutlery is missing. If it were to be sterilized in the autoclave, it would not only rust, but also contaminate the autoclave and, in the worst case, cause other instruments to rust.

According to a report by the SCENIHR panel, it is difficult to link the use of reprocessed products and infections. The main reason for this is the poor data situation on the health damage caused by reprocessed medical devices in Europe. So far, only individual cases have been described in which, for example, Creutzfeldt-Jakob disease, toxic and immunological reactions or disabilities have occurred, according to the report.

According to the experts, health hazards threatened above all from inadequate disinfection or sterilization or from chemical residues on the products. Chemical processes during processing could also cause material damage. The authors of the report conclude that the use of reprocessed single-use products poses a potential health risk. However, this does not necessarily have to be greater than that of non-processed products. The risk of infections with multi-resistant germs can never be completely ruled out in the event of multiple use.