A Comparative Analysis of Single-Use and Reusable Instruments in Podiatry - Essay Example

of the Study: A Comparative Analysis of Single-Use and Reusable Instruments in Podiatry I. Review of Literature Podiatry is a "field of healthcare devoted to the study and treatment of disorders of the foot, ankle, and sometimes knee, leg and hip- also collectively known as the lower extremity." (Wikipedia, 2007) The terms podiatry and chiropody are often confusingly used to mean the same thing. But Podiatry is actually used in the United States while Chiropody is usually adapted in the United Kingdom. An individual who is associated with the study and medical practice of Podiatry is called a podiatrist, podiatric physician, or podiatric professional. The term "podiatry" traces its roots in North America but has eventually been adapted even among English speaking members of the Doctors of Podiatric Medicine (D.P.M.) - an organization of podiatric medical school graduates. History of Podiatry The interest in studying the foot as well as appreciation of its importance to the beauty and health of an individual has already been seen in the early Egyptian civilization. A proof of which is the carvings showing work on hands and feet were seen at the entrance of the Ankmahor's tomb. As many Egyptologists would argue, early Egyptian civilization already had an idea of professional feet care. For instance, Hippocrates was one the first who described corns and calluses. He may also be considered as an early podiatric since he was one of the first who recognized the need to physically reduce hard skin, followed by removal of the cause. Hippocrates even invented skin scrapers for this purpose that eventually became the original scalpels. Records also show that Celsus who is a Roman scientist and philosopher was probably the one who gave 'corns' their name. Paul of Aegina then gave the definition of a 'corn' as "a white circular body like the head of a nail, forming in all parts of the body, but more especially on the soles of the feet and the toes. It may be removed in the course of some time by pairing away the prominent part of it constantly with a scalpel or rubbing it down with pumice. The same thing can be done with a callus." Chiropodists, who are also known as podiatrists and podiatric professionals nowadays, were not essentially considered as medical practitioners until the turn of the 20th century. Before, podiatrists were perceived as independently licensed physicians who cure diseases pertaining to the foot, ankle, and related leg structures but they were still separated from organized medicine. It was by a man named Lewis Durlacher who first recognized the need of Podiatry to be considered as a medical profession. With this in mind, Durlacher tried to establish the first association of podiatric practitioners in 1854. Some of the famous people in history who even hired their own personal podiatrists to tend their feet were the King of France, Napoleon, and President Abraham Lincoln. According to historical accounts, the former President Abraham Lincoln consistently had feet ailments that he hired a chiropodist named Isachar Zacharie. Such trust and friendship might have developed between President Lincoln and Zacharie that the former president even gave Zacharie instructions regarding national security. During the civil war, President Lincoln even sent Zacharie to confidential missions to deliberate and meet with leaders of the Confederacy. (http://en.wikipedia.org/wiki/Podiatry) Podiatry as a Medical Profession Podiatry's journey of being more than a folk form of medicine began with the formation of the first society of podiatrists and chiropodists in 1895. This was established in New York and in 1911 a school officially opened. A year later, a British society of podiatrists and chiropodists was also created at the London Foot Hospital where a school was also opened in 1919. In Australia on the other hand, associations of professional podiatric practitioners started to appear in 1924 onwards. In 1907, the first American journal in podiatry appeared. This was followed in 1912 by the UK journal in podiatry. The Australians were then able to introduce a training centre and a professional journal in 1939. Incidentally, the number of podiatrists and chiropodists greatly increased after the Great War and again after World War II. A possible explanation is that there were many ex-soldiers who found occupational opportunities in the practice of podiatry and chiropody. This gave a boost to the field of Podiatry, and even initiated the need for registration of all podiatric professionals in all English speaking countries. The sudden increase of foot care also led to an interest in Podology, the study of the foot. Since Podiatry is a serious medical profession, vigorous and advanced training must first be achieved by anyone aspiring to be a podiatric. One must first complete further studies at an accredited Podiatric Medical School. After which, the title of having a Doctor of Podiatric Medicine Degree must be granted to a would-be podiatric physician, or podiatric professional before they may pursue further education and practice in podiatric surgery. For instance, schools offering podiatry in the United States and much of Canada require students to complete almost a total of 12 to 13 years of education and training before finally being given the title of Doctor of Podiatric Medicine (D.P.M.). To be granted such a title, students of podiatry are required to take four years of undergraduate university training. The four years would focus on basic sciences just like any medical course. This is succeeded by another four years of medical training in an accredited school of podiatric medicine. Usually, rotations in hospitals and exposure to the different disciplines are done during the second through fourth years of medical training. In order to have a state or provincial license, additional residency training of around two or three years may also be required. This is done in most podiatric schools in the United States and much of Canada. If a podiatric would want to even be advanced in his or her career, he or she may still take up further fellowship training in a subspecialty of podiatry. (http://en.wikipedia.org/wiki/Podiatry) Studies on Reusable and Single-use Instruments Single-use versus reusable laparoscopic surgical instruments: A comparative cost analysis. The intention of this research was to investigate on the total annual costs for reusable and single-use surgical instruments in laparoscopy. This was done by analyzing a 12-month record of all laparoscopic operations that were done through reusable instruments. Data on what surgical instruments were used, depreciation costs, and all associated expenses like maintenance, repairs, cleaning, replacements, sterilization, and wages were also gathered. The total cost of the reusable instruments was then computed and compared with the total cost that single-use or disposable instruments would have caused for the same operations. The results of the study reveal that it would have cost more if single-use instruments were used for the same operations where reusable instruments were used. The discrepancy lies at a 7:1 ratio where using single-use instruments costs seven times more than using reusable instruments. The study concludes that employing reusable instrumentation instead of single-use instrumentation is still better for most laparoscopic operations. Nevertheless, single-use instruments can still be advantageous in special cases. The challenge therefore is to strike a balance between using single-use and reusable laparoscopic instruments. The bases of which are cost factors on one hand, and the identification of the best instrument available for certain procedures, on the other hand. (http://pt.wkhealth.com) Reusable instruments are more cost-effective than disposable instruments for laparoscopic cholecystectomy. The objective of this research was to evaluate the costs of reusable versus disposable instruments used during laparoscopic cholecystectomy. This is based on the rationale that surgeons can help their patients by limiting costs of operations since health care costs are obviously rising rapidly and becoming a burden to both patients and hospitals. This study proceeded by obtaining records on the costs to the hospital of reusable and disposable instruments. Specifically, the instruments studied were the Veress needle, trocars and sleeves (two 10 mm and two 5 mm), reducers, clip appliers, and clips. The costs of sterilization and sharpening for reusable instruments were also computed. In comparison with an assumed instrument life for 100 cases, the cost of reusable instruments was gathered. Data from a Canadian university hospital and three private hospitals were compared and analyzed. The records from the four hospitals showed that the costs of reusable instruments per case were $46.92-$50.67. The comparable costs for disposable instruments were $330.00-$460.00 per case. Theoretical advantages of disposable instruments such as safety, sterility, and better efficiency are not borne out in literature review. In addition, the environmental impact of increased refuse from disposable instruments could not be exactly defined. With the consideration of significant cost savings and the absence of data demonstrating disadvantages of their use, reusable instruments for laparoscopic cholecystectomy, are strongly recommended. (http://www.ncbi.nlm.nih.gov) Comparison of economic and environmental impacts between disposable and reusable instruments used for laparoscopic cholecystectomy. This research basically aimed to investigate the environmental and economic effects of disposable and reusable instruments used for laparoscopic cholecystectomy. Special consideration was given to the processing of reusable instruments in the Miele G 7736 CD MCU washer disinfector and the resultant cost of sterilization. The instruments frequently used in their disposable form were identified with the help of surgeons. Thus, of all the instruments used for laparoscopic cholecystectomy, the disposable and reusable versions of trocars, scissors, and Veress cannula were compared. For the case examined in this study, the performance of laparoscopic cholecystectomy with disposable instruments was 19 times more expensive that for reusable instruments. The higher cost of using disposable instruments is primarily attributable to the purchase price of the instruments. The processing of reusable instruments has little significance in terms of cost, whereas the cost for disposing of disposable instruments is the least significant factor. The number of laparoscopic cholecystectomies performed per year does not substantially influence cost. The study concludes that the assessment of the environmental consequences shows that reusable instruments are environmentally advantageous. Considering the upward pressure of costs in hospitals, this study is inclined to believe that disposable instruments should be used for laparoscopic cholecystectomy may be used if and only if they appear to present a clearer advantage over the use of reusable instruments. (http://cat.inist.fr/aModele=afficheN&cpsidt=16697100) A cost comparison of disposable vs. reusable instruments in laparoscopic cholecystectomy. This study compares the costs of disposable and reusable instruments in laparoscopic cholecystectomy. Instruments that are available in both a reusable and disposable form were considered as part of the main instrument set. A market study within the Belgian market was performed in order to compare purchase prices. In addition, costs of sterilization, cleaning, maintenance, wrapping, repair, and disposal of waste were computed. Through a comprehensive review of available literature, the effects of reusable and disposable instrumentation were analyzed. The results of the study reveal that the instrument cost per procedure of a full disposable set is 7.4-27.7 times higher than the cost per procedure with reusable instruments. In comparison with disposables, modular systems (semi-disposable) and mixed use of disposables and reusable instruments reduce costs, but still the cost per procedure remains higher than with reusable instruments. A sensitivity analysis confirmed that these conclusions are robust to the model assumptions. In addition, the available evidence in the literature suggests that reusable instruments do not compromise patient or staff safety. This study concludes that if reusable instruments are used instead of disposables when performing a laparoscopic cholecystectomy, considerable savings can be achieved without compromising patient and staff safety. (http://www.springerlink.com) A performance, safety and cost comparison of reusable and disposable endoscopic biopsy forceps: a prospective, randomized trial. Many gastroenterologists believe that disposable forceps are more expensive than reusable forceps. It has been shown, however, that cross contamination and spread of infection are possible with reusable forceps. In this study, a random assignment of endoscopists in reusable or disposable biopsy forceps during upper and lower endoscopy was done. Considering the ease of passage through the endoscope, forceps were evaluated as well as the ease of opening and closing, adequacy of sample, and overall evaluation succeeding the endoscopy that used an ordinal scale. The cost per biopsy session was calculated using the following formula: (Acquisition cost + Reprocessing costs)/Number of biopsy sessions. The results of this study reveal that disposable forceps received a predominantly excellent rating versus a predominantly good rating for reusable forceps. Disposable forceps were also found to be more cost-effective than reusable forceps with an average savings of $5. 94 per biopsy session. Examination of reusable forceps revealed residual patient debris despite "adequate" cleansing. Therefore, the study concludes that disposable forceps outperformed reusable forceps and were found to be more cost-effective. Residual patient debris on reusable forceps may pose a risk of cross contamination and the spread of infection. (http://www.ncbi.nlm.nih.gov) A comparison of reusable versus disposable laparoscopic instrument costs. Between 1991 and 1993 a single set of reusable laparoscopic instruments was used to perform 404 cholecystectomies, 102 hernia repairs and 66 advanced procedures. During the said period, disposable instruments were employed by the surgeons only when no suitable reusable instrument was available. Disposable instruments were also used only when reusable instruments were not working according to the satisfaction of the surgeons. The cost of performing those laparoscopic operations using this policy was calculated by adding the purchase cost, the maintenance costs and the repair and replacement costs of the reusable instruments. Added to this figure was the cost of disposable instruments which were used instead of reusable instruments during the study period. The results of the study reveal that the total cost was $253,385, at an average of $443 per case. The cost per case for reusable instruments remained approximately $100 through the 3 years, while the cost per case of disposable instruments fell from almost $600 in 1991 to about $200 in 1993. The conclusion of the study is to continue using reusable instruments initially, with backup disposable instruments. (http://www.ncbi.nlm.nih.gov) Biopsy Forceps: Disposable or Reusable This research is guided by the current debate surrounding the cost-effectiveness of disposable and reusable biopsy forceps. Performing a cost analysis was necessary to determine which forceps type is more cost-effective. Costs associated with disposable biopsy forceps include their initial cost as well as storage and disposal costs. In addition to initial cost, costs associated with reusable biopsy forceps include reprocessing, maintenance, and repair costs. Estimating the number of times forceps are likely to be reused is also essential to evaluating the cost-effectiveness of reusable biopsy forceps. In general, once a reusable biopsy forceps performs a threshold number of procedures, it becomes more cost-effective than a disposable forceps. While reusable biopsy forceps may be more suitable and cost-effective for larger gastrointestinal endoscopy centres that perform many procedures per day, the convenience of disposable biopsy forceps may make them the more appropriate choice for centres that are smaller and perform only a few procedures each day. Due to significant decreases in the initial cost of disposable biopsy forceps, the cost-effectiveness of reusable biopsy forceps is waning. (http://www.gastroenterologynursing.com) Efficacy and safety of reuse of disposable laparoscopic instruments in laparoscopic cholecystectomy: a prospective randomized study. The study's objective was to compare the quality and consistency of single-use adenotonsillectomy instruments available in the UK with reusable instruments and examine their performance in a clinical setting. The study's results revealed that between 40% and 93% of the instruments on each set were as good as the original and between 0% and 40% of the instruments were unacceptable from six sets of steel and one set of polymer instruments. 4151 procedures were monitored between 1 February 2003 and 31 March 2004 using a total of 41 376 instruments. Problems were reported with 335 (0.8%) instruments, 46% attributable to instrument design, 14% to poor design control and 13% to instruments escaping quality control systems. Following correction of the faults, between 1 January 2004 and 31 March 2004 the problem rate fell to 0.4%. The conclusion of the study is that the availability of high quality single-use instruments for tonsil and adenoid surgery is actually present. (http://www.ingentaconnect.com) Comparison of single-use bougie with multiple-use bougie. This research has studied the success rates for tracheal intubations in 32 healthy, anaesthetized patients during simulated grade IIIa laryngoscopy, randomized to either the multiple-use or the single-use bougie. Success rates (primary end-point) and times taken (secondary end-point) to achieve tracheal intubation were recorded. The multiple-use bougie was more successful than the single-use one (15/16 successful intubations vs. 9/16; p = 0.03). With either device, median [range] total tracheal intubations times for successful attempts were < 54 [24-84] s and there were no clinically important differences between these times. The study concludes that the multiple-use bougie is a more reliable aid to tracheal intubations than the single-use introducer in grade IIIa laryngoscopy. (http://pt.wkhealth.com) II. Data Collection Tool Design In gathering data from the records of the clinics and hospital, the following table will be used: Name of the Instrument Reusable or Single-use Initial Purchasing Cost Cost of Maintenance, Repair, Cleaning, Sterilization, etc. Cost of Disposal In gathering data from the doctors and other personnel of the clinics and hospitals, the following questionnaire with open-ended questions will be used: A. On the Use of Single-Use Instruments 1. How much do the clinic/ hospital spend on single-use or disposable instruments 2. Do you think the use of single-use instruments answer the question of disinfection 3. What are the advantages of using single-use instruments 4. What are the disadvantages of using single-use instruments 5. Would you advise the use of more single-use instruments in podiatry Why or why not B. On the Use of Reusable Instruments 1. How much do the clinic/ hospital spend on reusable or multiple-use instruments 2. Do you think the use of reusable or multiple-use instruments answer the question of disinfection 3. What are the advantages of using reusable or multiple-use instruments 4. What are the disadvantages of using reusable or multiple-use instruments 5. Would you advise the use of more reusable or multiple-use instruments in podiatry Why or why not III. Subjects The study will include the participation of three medical institutions that cater to podiatric patients- a clinic, a private hospital, and a public hospital. Records regarding the costs of both disposable and reusable instruments will be obtained from these clinics and hospitals. From each clinic or hospital, 100 cases of podiatric operations that were performed through reusable instrumentation will be studied. A complementary survey will also be done on podiatric doctors and other hospital or clinic personnel regarding their views on the advantages and disadvantages of using either reusable or single-use instruments in podiatry. IV. Data Analysis Since the data gathering techniques that would be employed in this study includes a comprehensive document research and a complementary survey, the data analysis would therefore exhaust information from the records of the clinics and hospitals as well as data from the questionnaires. Another source of data would be from the records taken from the updated search regarding the costs of purchasing and maintenance of both disposable/ single-use instruments and reusable/ multiple-use instruments particularly in the practice of podiatry. In the analysis of data for the reusable surgical instruments, it is to be understood that the computation of their total cost includes their initial purchasing costs plus their depreciation costs, and all associated expenses like repairs, maintenance, replacements, cleaning, sterilization, and corresponding wages for those maintaining it will all be covered. Likewise, the computation of the total cost for the disposable instruments includes the initial purchasing costs of the disposable instruments as well as the costs of storing and disposing them. References: Adler S, Scherrer M, Ruckauer KD, Daschner FD 2005, 'Comparison of economic and environmental Impacts between disposable and reusable instruments used for Laparoscopic Cholecystectomy', Journal Surgical Endoscopy, vol.19,pp.268-272, (online INIST-CNRS) Apelgren KN, Blank ML, Slomski CA, Hadjis NS (n.d.), 'Reusable instruments are more cost- Effective than disposable instruments for laparoscopic cholecystectomy', (online http://www.ncbi.nlm.nih.gov) Colak T, Ersoz G, Akca T, Kanik A, Aydin S 2004, 'Efficacy and safety of reuse of disposable laparoscopic instruments in laparoscopic cholecystectomy: a prospective randomized study', Journal Surgical Endoscopy. Vol. 18 (5), pp. 727-731, (online http://www.springerlink.com) Demoulin L, Kesteloot K, Penninck F 1996, 'A Cost comparison of disposable versus reusable instruments in laparoscopic cholecystectomy', Journal Surgical Endoscopy, vol. 10 (5), pp. 520-525, (online http://www.springerlink.com) Eddie G, White S. (n.d.), 'A comparison of reusable versus disposable laparoscopic instrument costs', (online http://www.ncbi.nlm.nih.gov) Marfin AG, Pandit JJ, Hames KC, Popat MT, Yentis SM (n.d.), 'Comparison of single-use bougie with multiple-use bougie', (online http://pt.wkhealth.com) Muscarella, Lawrence F. PhD 2001, 'Biopsy Forceps: Disposable or Reusable', Gastroenterology Nursing. 24(2):64-68, (online http://www.gastroenterologynursing.com) 'Podiatry' 2007, Wikipedia: The Free Encyclopedia, viewed 28 January 2007, http://en.wikipedia.org/wiki/Podiatry Rizzo J, Bernstein D, Gress F. (n.d.), 'A performance, safety and cost comparison of reusable and disposable endoscopic biopsy forceps: a prospective, randomized trial', (online http://www.ncbi.nlm.nih.gov) Schaer, Gabriel N. MD; Koechli, Ossi R. MD; Haller, Urs MD 1995, 'Single-use versus reusable laparoscopic surgical instruments: A comparative cost analysis', American Journal of Obstetrics & Gynecology. 173(6):1812-1815, (online http://pt.wkhealth.com). Tomkinson A, Phillips P, Scott JB, Harrison W, De Martin S, Backhouse SS, Temple M 2005, 'A laboratory and clinical evaluation of single-use instruments for tonsil and adenoid surgery', Clinical Otolaryngology & Allied Sciences. Vol. 30 (2), pp. 135-142, (online http://www.ingentaconnect.com) Read More