Agarwal Aakash, MacMillan Adam, Goel Vijay, Agarwal Anand K, Karas Chris
Department of Bioengineering and Orthopaedic Surgery, Engineering Center for Orthopaedic, Research Excellence (E-CORE), University of Toledo.
Spinal Balance Inc., Toledo.
Clin Spine Surg. 2018 Aug;31(7):308-311. doi: 10.1097/BSD.0000000000000675.
Given the complexity of the sterilization process, and the risk involved in absence of strict adherence to the protocol described by the medical device manufacturers, terminally sterilized devices are emerging and being promoted in the field of medical practices. The characteristics associated with conventional reprocessing are demanding logistics, costs of delay, operations and adverse events, and unacceptable liability. Demanding logistics were a result of decoupled staff between the operating room and sterilize processing department, understaffed and high-volume processing with an additional burden due to inventory management and inefficient training. Other costs arose from upkeep, delay in operating room, and surgical-site infections. Liability arose from the repeatedly use of an unquantifiable process thus adding uncertainties, limited shelf life of the reprocessed implants, contingency of flash sterilization and introduction of newer technology with higher demand on cleaning performances. In contrast, terminally sterilized single-use devices do not carry any of the aforementioned-characteristics, deeming it to be the simplest solution to the current conundrum. This review serves to provide an evaluation of logistics, costs, and potential adverse effects, both directly and indirectly, associated with current practices in the sterile processing department, and also describes as to how the use of terminally sterilized devices can help circumvent those.
鉴于灭菌过程的复杂性,以及在未严格遵守医疗器械制造商所描述的规程时所涉及的风险,最终灭菌的器械正在医疗实践领域中出现并得到推广。与传统再处理相关的特点包括苛刻的物流要求、延误成本、操作和不良事件,以及不可接受的责任风险。苛刻的物流要求是由于手术室和消毒处理部门之间人员脱节、人员不足且处理量大,再加上库存管理和低效培训带来的额外负担所致。其他成本来自维护、手术室延误和手术部位感染。责任风险源于对一个不可量化过程的反复使用,从而增加了不确定性、再处理植入物的有限保质期、快速灭菌的偶然性以及对清洁性能有更高要求的新技术的引入。相比之下,最终灭菌的一次性器械不具备上述任何特点,这使其成为解决当前难题的最简单方案。本综述旨在对消毒处理部门当前实践直接和间接相关的物流、成本及潜在不良影响进行评估,并阐述使用最终灭菌器械如何有助于规避这些问题。