Benefits of Single-Use
The benefits of single use medical devices can be summarised as follows.
1. Patient Safety

 

The principal objective of a Central Sterile Supplies Department (CSSD) in reprocessing reusable medical devices is to ensure that any contamination on the device from the previous patient is fully removed and is ready to be used on a subsequent patient safely. There are several challenges that make the reprocessing of medical devices difficult.

Bacterial Biofilms
Biofilms are densely packed communities of microbial cells that grow on living or inert surfaces and surround themselves with secreted polymers. Many bacterial species form biofilms, and their study has revealed them to be complex and diverse.
They are difficult to remove from medical devices using conventional CSSD decontamination processes.
Bacterial Biofilm Formation
– 5 Stages.
Attachment
Bacteria attach to a variety of surfaces, from metal, to plastic, to skin tissue, using specialised tail-like structures.
Growth
The Cells grow and divide, forming a dense matrixed structure, many layers think. At this stage the biofilm is too thin to see.
Maturation
When there are enough bacteria in the developing biofilm the bactria secrete a slimy extracellular matrix of proteins and polysaccarides.
Detachment
The slime protects the Bacteria from the harsh environments shielding them from many chemicals, antibodies and immune systems.
Re-development
As the colonies mature, the structures created weaken and cast off bacteria that look for new places to grow and prosper.

Reference: Journal of Hospital Infection (2004) 58, 224-2

In the paper by Pajkos, Vickery and Cossart and published in the Journal of Hospital Infection clear evidence was presented of the existence of biological deposits in all endoscopes and bacterial films in five out of the thirteen endoscopes examined. Routine cleaning procedures did not remove biofilms and can be a source of infection to subsequent patients.

Intragenic Transmission of CJD

Intragenic transmission of the CJD agent has been reported in over 500 patients. These cases have been linked to the use of contaminated human growth hormone, dura mater and corneal grafts, or neurosurgical equipment. Of the six cases linked to the use of contaminated equipment, four were associated with neurosurgical instruments, and two with stereotactic EEG depth electrodes.

Infection Control I Creutzfeldt-Jakob Disease, Centre for Disease and Control Prevention

Prion-Related Diseases Workup Creutzfeldt-Jakob disease in a 52 year-old woman with florid plaques. The Lancet 1996

Ref: Outpatient Surgery, A Division of AORN 2018

More than 60% of correctly processed surgical instruments exhibit residual protein soiling.Porter Adventist Hospital in Denver, Colorado suffered a two-year (2016-2018) episode of post-operative infections linked to the presence of bacterial biofilms on surgical instruments used on patients.

2. Cost Effectiveness

With the introduction of single use medical devices, concerns have been raised with regards to the increase in costs compared to reusables.

  • The use of single use devices removes the need for re-processing and repairs. It also eliminates the risk of cross-infection from a reusable device.
  • Reusable devices have an environmental impact with the use of detergents and steam used in processing.
  • Several studies have carried out systematic review of the cost effectiveness analysis of reusable versus single devices and have concluded that there are financial benefits from the use of single use devices.

Anaesthesia (2019) A Review Article: A systematic review and cost effectiveness analysis of reusable vs. Single-use flexible bronchoscopes. Mouritsen et al.

3. Save Time

The use of single use instruments saves time as instruments do not have to be reprocessed. This means that planned surgery is not curtailed because reprocessed instruments have not been turned around in time.
Clonallon worked with a Dental Hospital who were experiencing on-going problems in getting the instruments used in a morning clinic reprocessed and turned around for the afternoon clinic.
Switching to single use instruments meant that a full clinic could be run in the afternoon. Additionally, as single use instruments have not been subject to wear and tear it means that replacing a functioning instrument is not required.

4. Environmental Impact

The re-processing of reusable medical devices involves the use of detergents many of which contain phosphates which are known for causing algae blooms when discharged into water courses. Chemical disinfectants are also used in the reprocessing of devices. The use of steam under pressure is commonly used to sterilise chemically cleaned devices and this steam is cooled and discharged as hot water into waste treatment units causing thermal pollution.
A comparative study on environmental impact of reusable and single-use Bronchoscopes using a simplified life-cycle-assessment methodology concluded that there was a higher environmental impact reprocessing a medical device after a second reprocessing event.

American Journal of Environmental Protection 7, Issue 4, August 2018, pages 55-62. Sörensenet al.