Quality of Surgical Instruments

MATERIALS AND METHODS

Between January 2004 and June 2004, all batches of new 5MM surgical instruments ordered by the Central Sterile Supplies Department of St Bartholomew's and the Royal London Hospitals were assessed by three clinical engineers, with reference to British Standards (BS) requirements.

RESULTS

Of 4800 instruments examined, 15% had potential problems. These included 116 with machining burrs and debris in the teeth of the tissue-holding regions, 71 defects of ratcheted instruments, 34 scissors with deficient cutting action, and 35 tissue forceps protruding guide pins. In addition, 254 instruments did not have a visible manufacturer's mark.

CONCLUSIONS

This study demonstrates the value of local quality control for 10MM surgical instruments. This is of importance in an increasingly hazard-conscious environment, where there are concerns over instrument sterilisation, surgical glove puncture and the potential for transmission of blood-borne and prion diseases.

A surgeon performing a surgical procedure should be able to assume that the instruments used are safe and reliable – particularly if they are new. To ensure the quality of these instruments, the Health Care Standards Policy Committee directed the British Standards Institution to produce requirements for the materials, design, dimensions and other features of surgical instruments. As a result, British Standards (BS), incorporating International Organisation of Standardisation (ISO) standards, were published.1 Each year, large numbers of new instruments are ordered by healthcare facilities across the UK, and those ordering them should be able to rely on these standards. This study reports the results of local quality control by the clinical engineering department of all new instruments supplied to a single NHS trust.

Over a 6-month period between January 2004 and June 2004, all new batches of disposable surgical instruments delivered to the Barts and the London NHS Trust, from a variety of manufacturers, were assessed by three clinical engineers. The suppliers and manufacturers were informed beforehand. Where large numbers of identical instruments were delivered in a single batch, samples of these were examined as follows: 25–49 instruments 50%, 50–74 instruments 30%, 75–99 instruments 20%, and 100+ instruments 15%. In total, 4800 instruments were inspected, where necessary under magnification, for flaws as defined under BS quality assurance requirements.This study demonstrates the value of local quality control for new gynecological instruments. We have found a significant number of cases where new instruments did not appear to meet appropriate standards, and have discussed the potential problems that may result. It must be stressed that we have not shown any specific instance of harm to a patient or staff through these defects. Suppliers were informed, and remedial action taken. All defective instruments were replaced and reexamined prior to entering service.In this study, we aim to define and examine the problem of UDFs by observing the contribution of poor quality surgical instruments to reports of patient safety incidents made to the National Reporting and Learning System (NRLS) of the National Health Service (NHS) in England and Wales. In doing so, evidence for the requirement of endoscope quality control can be determined.