Reuse of single use supplies - The pendulum swings

Prior to 1970, most items of medical equipment were reusable. AIDS, hepatitis-B and other infection control concerns led to the development and eventual requirement for single use items. This theme has been broadly applied by suppliers because of increased profit margins. In the civilian sector, these costs are "passed through" to insurers or paid by government programs. As an Army medical center, we have no "pass through" capability and a capped budget. Our hospital infection control policy forbids reuse of single use items. Our gastroenterology budget would be used several times over if single use items were not reused. Our goal was to design and implement a plan for reusing single use items which would be satisfactory to the hospital commander, infection control, and Joint Commission for Accreditation of Hospitals Organization (JCAHO) and still be cost effective and insure patient safety. METHODS: Over 1,000 ERCPs were reviewed at Brooke Army Medical Center. All of these procedures were done using reused single use items, a practice probably more widespread than admitted. No infectious complications attributable to supplies were reported with any of these procedures. With this track record, a list of suitable items for reuse was made. Coiled wires and other difficult to clean items were excluded. A cleaning and sterilization process was designed. A tracking system and a monitoring system of random item cultures was implemented. Input was taken from the hospital commander, infection control, nursing, gastroenterology staff and technicians, central supply, and the legal office. Equipment manufacturers contacted were uniformly noncooperative in designing sterilization procedures. RESULTS: A plan was developed, signed by the commander and implemented. Our plan has now been in effect for one year. An in depth inspection by JCAHO met with approval. No infectious complications have occurred. Our infection control policy was changed to allow reuse. CONCLUSION: We continue to saved hundreds of thousands of dollars reusing single use items while preserving safety. Our procedure is approved by regulatory authority. Manufacturers are again beginning to produce reusable items.