Single-use verses quality surgical instruments – what’s the true value?

Todays disposable world even reaches as far as the operating theatre. A question that surgeons, nurses, theatre practitioners, CSSD departments must answer is, "What is more cost effective; single-use surgical instruments or re-useable quality made instruments?" Sterilisation departments have changed dramatically over the past 10 years moving away from the small operating theatre cleaning and repair rooms with "little-sister" autoclaves, to massive, out-sourced sterilisation departments, often built miles away from the local hospital. These stand-alone, sterilisation businesses have changed the way that many operating theatre's now work with instruments. The time taken to move used instruments to the sterilisation department, for them to be cleaned and re-sterilised and returned to the hospital, is often days. Hence the need to have more instrument sets or to rely on single-use instrument packs. However, what is the true value to surgical instruments, both re-useable and single-use. What is the economic and environmental impact to society of these devices? After all, surgical instruments are largely made of medical grade steel and even tungsten, which then go into land-fill after just one use! And who makes surgical instruments so cheaply that they cost less to buy than to re-sterilise? One can rightly assume that a fair proportion of this is down to child labour and low wages. Meanwhile, the actual skill of hand-finishing and sharpening the tungsten insert on a Gorney-Freeman face lift scissor (for example) at the Snowden Pencer plant in Tucker, Georgia, USA is a dying engineering job. The last two Snowden Pencer skilled instrument technicians are destined to be lost if and when Becton Dickinson, the current owners, finally close the plant down. This will be a sad loss, not only for historical reasons, but for all surgeons who are passionate about the tools of their trade. The old adage "a bad workman blames his tools" is not one I hear to often in the operating theatre's, however perhaps that will all change when the single-use instruments have replaced the care, attention, love and skills that use to go into a high quality surgical tool.