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Some practices have given up doing any minor surgery to the annoyance of consultants and patients alike. Decontamination regulations may have been the final straw. We seem to be facing falling enhanced services budgets.

Centralised CSSD solutions are expensive, as they have to include transport costs and initial stock. Practices become dependent on a local NHS monopoly supplier.

Compliance can be achieved in-house with the purchase of vacuum sterilisers that give printouts of each cycle. They are expensive in both capital and revenue; maintenance contracts have to be kept. Staff time is taken up by cleaning, running the sterilisation cycles and documenting it all.

The maintenance contract for an old non-vacuum steriliser was more than £500 a year. We decided to scrap in-house sterilisation altogether and go to single-use equipment.

The costs of single-use equipment for my surgery of 2,650 patients will be around £700 a year. But even if that goes up to £1,000, it will be worth every penny in reduced clinical risk and staff time.

We have used disposable speculums for some time. The decision to scrap the steriliser was finally made when we found disposable metal minor surgery kits. You can buy the individual bits such as scissors and forceps or as a pack with a sterile field. Plastic disposable forceps are horrid. A standard suture pack with all metal items costs £2.90.

Pictures of what we use and links to the regulations are on

Dr Gerard Bulger

Bovingdon, Herts

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