Choosing consumables and reusable equipment
When choosing which consumables and reusable medical devices to stock, practices need to consider in addition to cost (Table 12.1. Considerations for purchasing consumables and reusable equipment).
Table 12.1. Considerations for purchasing consumables and reusable devices
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Parameter
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Considerations
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Quality
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The extent to which the product performs its defined function without contributing to transmission of infection
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TGA approval
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Whether the item is listed in the Australian Register of Therapeutic Goods
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Safety
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Whether the item can be appropriately cleaned, disinfected or sterilised. Check manufacturer safety data and instructions
Whether the item will have infection prevention and control implications for other consumables, equipment or plans
Whether any difficulties in cleaning and reprocessing the product may impact on the product’s functionality and safety
Whether any alternative products that are available may present a lower risk of infection
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Cost-benefit analysis
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Unit cost, maintenance costs including hidden expenses such as staff time and other resources (eg cleaning and/or disinfection requirements)
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Waste minimisation
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Disposal requirements in accordance with legislative compliance
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Serviceability and availability
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Availability, reliability of supply chain
Maintenance requirements
Service agreement and warranty
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Single-use items
Single-use devices must not be reprocessed for reuse.
A manufacturer may classify its product as single use for several reasons including:
- cleaning difficulties posed by sharp or narrow lumen reusable medical devices
- materials used in the manufacture of the item may not withstand the cleaning and sterilisation process (eg some plastics in nebuliser sets, tubing, spacers and syringes may distort or melt, low-grade stainless steels in disposable sets may rust)
- significant work health and safety risks posed in reprocessing (eg needles for injections, neurological testing, acupuncture and suturing, scalpel blades, lancets and stitch cutters).
Even practices that reprocess their own equipment will still use many single-use items. Practices need to have stock control policies to ensure a ready supply of single-use stock is available as required. For example, practices could have essential disposable instruments available in the event of a reprocessing equipment (eg steriliser) breakdown.
The advantages of single-use items are that they minimise the risk of cross-infection, reduce the work health and safety risks of reprocessing and sterilising, and reduce the staff time and cost of onsite sterilisation. Some practices, especially those that rarely perform procedures requiring sterile reusable medical devices, will find it more economical to maintain a range of pre-packaged, single-use sterile items to manage their anticipated needs.
The disadvantages of single-use items are that their unit cost may be higher, may have a greater environmental impact, require storage space, and require a reliable supply chain (practices may need to keep larger amounts of disposable stock as a buffer). Quality varies between brands.
Lancets for blood testing
Lancets should be of the spring-loaded, retractable, single-use variety for most applications. The main exception is disposable nonretractable single-patient lancets used multiple times for allergy testing on a single patient and then discarded.
Plates or bases of reusable spring-loaded devices are a potential source of cross-infection and pose an unacceptable risk to patients in general practice and other office- and community-based practices. However, their use is appropriate for single-patient home use where instructions on thorough cleaning are provided.
Changing the plates or bases and reloading with new but unprotected lancets poses a work health and safety risk.
Auroscope tips
Practices should use disposable auroscope tips.
Reusable auroscope tips are not appropriate for office-based practices because cleaning is difficult. Although inexpensive, they require significant staff time to carefully clean small lumens with fine brushes to remove wax contamination. Imperfect cleaning is a hazard.
Spirometer and peak flow meter mouthpieces
Single-use mouthpieces must be used in practices. Spirometers must use inline viral/bacterial filters.
Peak flow meters are for single-patient use only.
Spacers for use with pressurised metered-dose inhalers
Practices can keep cardboard disposable spacers for use when a patient does not have their own spacer (see Respiratory equipment).
Metal spacers (rarely used) and some plastic spacers can be sterilised, but most plastic spacers are for single-patient use and cannot be sterilised.