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Introduction: Cotton as well as synthetic textile medical products are widely used as barrier materials and individual protection against displacement of biological infectious factors. The required level of protection of these products for multiple use and disposable multilayer laminates against the penetration of microbes depends on the risk connected with type of surgical procedure defined in normative documents. METHODS. Cotton and syntetic medical textiles for multiple use, 30-times subjected to processes simulating conditions of the use as well as disposable multilayer surgical drapes were tested. Resistance to microbial wet penetration was conducted according to the PN-EN ISO 22610: 2007 standard., Results: The barrier of cotton fabrics was reduced after first washing and then systematically grew after each often cycles to the value close to the value at the beginning. From the twentieth cycle of simulated conditions of the use, barrier index was reduced. The barrier of the synthetic textile stayed on the average level, while multilayer disposable products ensured the full impermeability for the bacteria., Conclusions: Natural cotton textiles for multiple use could be apply on operative blocks in limited range because of the changes of the cotton structure caused by repeated laundering process and sterilization. Synthetic materials also have limited application, although are more resistant to cleaning and sterilization processes. Disposable synthetic laminates with many layers use guarantee impermeability for bacteria and may be applied in operative blocks without restrictions.

Background: Reprocessing of single-use medical instruments has been proposed as a mechanism for managing the rising costs of health care. We compared the performance of new and reprocessed laparoscopic trocars., Study Design: New and reprocessed laparoscopic trocars were evaluated. Testing consisted of visual and microscopic inspection, force of trocar insertion and removal through a porcine abdominal wall, trocar seal leak rate determination, and testing of blade shield speed., Results: Three hundred twenty-eight reprocessed trocars and 199 new trocars were evaluated. Trocars undergoing force testing were inspected for imperfections. In this group, 28.2% of reprocessed and 3.79% of new trocars manifested some gross or microscopic imperfections (p = 0.063). D12LT trocars (Ethicon) required more force with insertion with reprocessed compared with new trocars (0.021). D5LT (Ethicon) new trocars required more force to remove than reprocessed trocars (p = 0.004). Both the shield cover time and the shield response time were found to be faster in the reprocessed (p = 0.0001) compared with the new trocars. Leak testing performed with probes (4.7 mm and 12.9 mm) in place demonstrated a significantly greater amount of leakage for the reprocessed trocars compared with the new trocars, both before and after insertion of the right-angled instrument (p = 0.0001)., Conclusions: When comparing new and reprocessed trocars, there are significant differences in visual trocar defects, insertion and extraction forces, shield response times, and trocar leak rates for some of the device comparisons. The clinical significance of these changes should be weighed against cost savings and environmental impact. Additional testing is necessary for a better understanding of the impact of trocar reprocessing., (Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: To compare the mechanical and clinical performance of new and reprocessed harmonic scalpels (HS)., Methods: A total of 89 reprocessed and 90 new HS (laparoscopic coagulating shears with a curved blade and 5-mm-diameter shaft) were subjected to visual inspection, destructive testing, and nondestructive mechanical testing. Subsequently, new HS, randomly selected reprocessed HS, and selected reprocessed HS with known abnormalities were graded on clinical performance by 14 surgeons in a porcine model., Results: Visual inspection of the HS discriminated between the new and reprocessed instruments in 11 of the 12 visual criteria (P < or = 0.02). In vitro mechanical testing revealed greater clamp arm dislodge forces for the new HS (P < 0.01) and greater midshaft temperatures for reprocessed HS (P < 0.01). Overall, 65 (73%) of 89 reprocessed and 7 (7.8%) of 90 new HS had gross abnormalities noted on inspection and mechanical evaluation (P < 0.01). The surgeons' evaluation of the instruments during in vivo testing demonstrated that the new instruments manifested significantly greater hemostatic control compared with randomly selected reprocessed HS (P = 0.01) and were significantly better for tissue sticking (P = 0.01), tissue transection (P = 0.02), tissue dissection (P < 0.01), grasping (P < 0.01), and hemostatic control (P = 0.04) compared with reprocessed HS with obvious defects., Conclusions: In vitro and in vivo data demonstrated significantly greater performance for new HS compared with reprocessed HS. Mechanical testing of reprocessed HS could not adequately distinguish which HS would result in decreased performance. These findings raise important issues of clinical safety in the contemporary quest for cost-effectiveness.

Reprocessing of endoscopic instrumentation reduces the risk of transmitting infectious organisms to patients and health care workers. Health care workers should use the Bloodborne Pathogen Standard and Standard Precautions to determine the best method to reduce and/or eliminate bioburden.

Financial pressures imposed on hospitals by health maintenance organizations and insurers have prompted investigation into alternative procedures that reduce expenses while maintaining the high standards required for patient care. Although not necessarily mutually exclusive, these dual agendas pose a challenge for endoscopy managers charged with balancing the risks and benefits of reusable and disposable endoscopy instruments. Our endoscopy unit elected to evaluate the feasibility of reducing costs by using reprocessed single-use devices. Following the selection of a third party reprocessor and prior to using any reprocessed devices in the clinical setting, our facility decided to submit single use devices that had been used once for reprocessing and then have an independent laboratory test them for sterility. Although we followed a thorough, multi-disciplinary approach, our end result led us to conclude that the cleaning, reprocessing, and resterilization of single-use biopsy forceps and snares is a greater challenge than previously anticipated. Reprocessing of the single-use devices tested did not result in endoscopic instruments that met acceptable standards for sterility at our institution.

Presterilized (disposable) syringes and needles were subjected to sterility testing for aerobic cultures. It was found that 56.3% of the samples were contaminated indicating failure of the sterilisation process. The implications of this could be far reaching and is discussed alongwith.