Going green in the hospital

February 24, 2010

Wider adoption of the practice of recycling medical equipment -- including laparoscopic ports and durable cutting tools typically tossed out after a single use -- could save hospitals hundreds of millions of dollars annually and curb trash at medical centers, the second-largest waste producers in the United States after the food industry.

The recommendation, made in an analysis by Johns Hopkins researchers in the March issue of the journal Academic Medicine, noted that with proper sterilization, recalibration and testing, reuse of equipment is safe.

"No one really thinks of good hospitals as massive waste producers, but they are," says lead author Martin Makary, M.D., M.P.H., a surgeon and associate professor of public health at the Johns Hopkins University School of Medicine. "There are many things hospitals can do to decrease waste and save money that they are not currently doing."

Hospitals toss out everything from surgical gowns and towels to laparoscopic ports and expensive ultrasonic cutting tools after a single use. In operating rooms, some items that are never even used are thrown away -- single-use devices that are taken out of their packaging must be tossed out because they could have been contaminated. Selecting such good devices for resterilization and retesting could decrease the amount of needless waste from hospitals.

And, the researchers say, hospitals could procure more items designed to be used safely more than once after being sterilized.

Hospitals, they add, are increasingly attracted to reprocessing because recycled devices can cost half as much as new equipment. Only about a quarter of hospitals in the United States used at least one type of reprocessed medical device in 2002, and while the number is growing, the practice is not yet widespread, they say. Banner Health in Phoenix, they write, saved nearly $1.5 million in 12 months from reprocessing operating room supplies such as compression sleeves, open but unused devices, pulse oximeters and more.

Safety concerns with reprocessing include possible malfunction of devices, the risk of transmitting infections, and the ethical dilemma that reprocessing presents given the absence of patient consent to usage of such devices in their treatment. The government requires all reprocessed equipment to be labeled as such, along with the name of the reprocessing company. A recent study by the U.S. Government Accountability Office concluded reprocessed devices do not present an increased health risk over new devices.

"These devices are safe, but it's a public relations challenge," Makary says. "Some people don't like the idea that they're being treated with equipment that has been used before. But these reprocessed devices are as good as new since the testing standards for reuse are impeccable and there have been no patient safety problems in our analysis."
-end-
The other authors of the commentary are Gifty Kwakye and Peter J. Pronovost, M.D., Ph.D., both of Johns Hopkins.

For more information: http://www.hopkinsmedicine.org/surgery/faculty/Makary

Johns Hopkins Medicine

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