When costs are top of mind for every department in a hospital, the choice of single-use devices or reusable devices is an important one. Healthcare professionals today are not only understaffed but under constant pressure to keep costs low. Reprocessed single-use medical devices have been around for quite some time and many professionals are taking a closer look at what their organization is doing in terms of reprocessing single-use devices. Not only can reprocessing single-use devices be cost effective, but it has environmental benefits as well.
Editor’s Note: Our special feature this month is about sustainability in the healthcare system.
According to an article from APIC, “Increasing healthcare costs, environmental concerns, and recognition of finite resources have prompted healthcare facilities to consider reprocessing devices labeled as single-use devices. At the same time, concerns over the safety of reprocessed single-use devices led the U.S. Food and Drug Administration to develop and publish regulations for this practice. Under these regulations, reprocessors, hospital-based or third party, must meet the same standards as the original manufacturer.”
The article adds that “For several decades, hospitals and private healthcare establishments have reprocessed various single-use devices (SUDs). The practice of using SUDs was promoted as labor-saving and cost-efficient. By 1982, at least two-thirds of all sterile devices used carried a label saying, ‘for single use only.’”
Further, “Concerns about healthcare costs, changes in the reimbursement system, and concerns about the environmental impact of disposing of these devices prompted healthcare facilities to evaluate the feasibility of reusing such devices. The U.S. Public Health Service approval of the practice of reusing hemodialysis filters led the way for current activity.”
“Manufacturers choose whether or not to label a device ‘single use,’ and they are not required to provide evidence to support their designation,” the article added. “Many manufacturers attach the single-use label to devices they previously marketed as reusable or currently market them as reusable outside the United States. At the same time, the U.S. Food and Drug Administration's (FDA) Medical Device Reporting system has documented few adverse events associated with the reuse of SUDs.”
Healthcare Purchasing News had the opportunity to speak with Maureen Spencer, M.Ed, BSN, RN, CIC, FAPIC, infection preventionist consultant and Lars Thording, VP, marketing & public affairs, Innovative Health about their views on single use vs. reusable devices.
Regarding her background, Spencer says, “So my consulting experience is really more with companies. One of the things we focus on is bringing new vendors into infection prevention (IP) to try to help them navigate the world of IP and some things we've found useful to navigate that world.”
Instructions for use
As for best practices and guidelines, she said, “APIC has some guidelines and then of course we have the instructions for use (IFU) from the manufacturers when they're going to label it single use, like harmonic scalpels or disposable blood pressure cuffs. Additionally, they're now pushing endoscopy equipment that's disposable but it's very expensive.”
Spencer added, “We follow the IFUs, and some people are very strict about it. They don't want any legal responsibility. Some hospitals say if it says disposable, single use then that is what we do. Then other hospitals have decided to look at various equipment from these companies that offer sustainability systems and have had success in reprocessing certain equipment like harmonic scalpels. The problem is they're pushing disposable, like in the endoscopy area, because they can make a lot of money and they're saying, ‘Well, then we won't have these outbreaks.’”
She comments that, on endoscopes, there is data available on how to clean out, for example, crevices where rubber starts to crack after a period of time. “I would push for something like that rather than disposable endoscopes, because I think it is just too cost prohibitive for companies,” she added.
Going green
What about the environmental impact of reusing instruments or devices? Thording said, “There is a lot of interest in hospitals in becoming greener, but unfortunately road maps and handbooks are few and far between. A couple of government agencies recently have tried to launch some toolboxes, but I would say in general, frankly, it's been very hard for hospitals to adopt things like environmentally preferred purchasing.”
Thording added, “Meaning that in our consideration for what products to purchase and use in the hospital, we will favor products that are environmentally favorable. Because almost all purchasing decisions in healthcare are based on something else—costs. So, that is a major barrier.”
Best practices
“As for best practices in hospitals, I would say number one is creating tools so that everyone from physicians to administrators to technologists are aware of the environmental impact of what the hospital does,” Thording commented. “Transparency is a part of the solution itself. I think to some extent when physicians don't take the environmentally preferred device, it's probably because they're not aware.”
Thording noted that best practice number two is to make environmental considerations a part of the purchasing decision making. And that's something that easily fits within the purview of the Value Analysis Committee. The Value Analysis Committee gathers people from many different functional areas to make decisions about what products to adopt.
Thording stated, “Number three is the background. The vast majority of a hospital's carbon emission footprint does not come from what the hospital does. It comes from what? The hospital buys so that means that most of the carbon emissions are coming from what is called scope 3 emissions. That is from the products and stuff that the hospital buys. So ask your suppliers to provide accounting of carbon emissions footprints of the devices that they're selling. It’s difficult to do, but it's becoming more and more normal to be able to provide that kind of accounting and it really should be standard practice to demand that as a supply chain because it is a supply chain that is responsible for most of the waste and most of the carbon emissions.”
“And number four is that when there is a choice between reusable and single use devices to favor the reusable one, but in many cases, the fact is that that choice is not there,” he said. “That type of device is simply just single use or that type of device is not reusable. This not only relates to the infection preventionists, but it relates to OR directors, as well. If it involves surgical instruments like the harmonic scalpels of the trocars, they probably have a surgeon that does that kind of surgery approve and give their input into it. This does involve teamwork: it involves a group of people together working with the vendor on what the vendor can do, and the process of collecting everything in those green bins to get those back to the loading dock and on the trucks that bring them to this facility. And then they reprocess them and get them back into stock. There are some surgeons when they see it's a reprocessed harmonic scalpel, for instance, might reject it and say, ‘I don't want use one that's reprocessed. I want one that's brand new.’ Sometimes that's the influence of a vendor.”
Recycling
Thording also mentions a barrier to reprocessed single-use devices. “Now, when the purchasing department is willing to look at environmental considerations, they get a conflicting message from leadership of the hospital: You need to reduce your costs and you need to pick the more environmentally friendly option,” he said. “The problem is that in most cases, environmentally friendly solutions are more expensive than the cheapest product in the market. So that's definitely a barrier.”
Thording concluded by saying “Recycling is a big barrier to reprocessing. I just put the devices over here and somebody takes them, and it gets recycled. But the fact is now it's out of circulation. So now it can't be reused, which is expensive for the hospital and recycling usually does not yield really even close to the carbon emission results as reprocessing does.”
