Medical instruments, including vaginal specula, can be used correctly or incorrectly. Incorrect use is associated with increased risk of infection for patients and increased liability risk for doctors. Part of the problem may be that doctors do not know how to use these tools correctly and another part of the issue may be more related to economics.

Lack of Knowledge

A literature review performed to assess what was already known about doctor’s practices as they pertained to decontamination found out that many doctors did not know what sterilization meant and confused it with disinfection. Doctors were not the only source of improper practices as there was one case study where a nurse was washing specula in disinfectant rather than sterilizing them in an autoclave.

In-Office Sterilization

Many physicians’ offices have a Benchtop Steam Sterilizer (BTSS) for autoclaving equipment. However, most offices do not adhere to best practices regarding BTSSes including regular maintenance and weekly checks of functionality. Because most BTSS are not being used in the correct manner and doing so is potentially costly, it might be prudent for many doctor’s offices to switch to disposable specula.

Issues with Disposables

Disposable tools such as the common vaginal speculum lower the risk of infection for patients when used correctly. They provide an alternative to sterilization of reusable products when this option is not available or is too costly. However, disposables have their own issues as well.

The major issue involving disposables is that they may be reused in spite of the label warnings that this is not recommended. Even if a doctor attempts to decontaminate a disposable speculum it may not have the desired results because the object is not made to be reused. This could lead to a false sense of safety regarding disposable instruments that have been through decontamination procedures but may not actually be sterilized.

Another issue with disposable tools is the cost. When used correctly disposables must be discarded after each patient visit and thus can be pricey for doctors who go through a lot of them. One option that can lower the cost is for a Primary Care Trust (PCT) or other organization to purchase the items in bulk and then ship them out to the doctors as needed.

Economic Costs and Liability

Although switching from improperly decontaminated items to the proper use of disposable options may involve an additional cost, surveys indicate that many doctors are willing to take on this cost in order to improve patient safety. Not only does adhering to best practices protect patients but it also protects doctors. Doctors who ignore best practices could be held liable for their actions.

Doctors and nurses often do not follow best practices because of ignorance about why they are important. Infection control nurses can help health professionals understand why these practices are so essential to patient safety and help them implement changes in order to reach basic standards of care. Single-use tools, never reused, usually provide the best balance between safe care and economic costs.