Sustainability and Reporcessing Single Use OR Items
Shiu-Yi (“Emily”) Chen MD and Galixy Li MD
There are certain things that occur in our daily professional lives that are just so insane and crazy I sometimes want to pull a Howard Beale from the 1976 movie “Network” and stick my head out a window and scream: “I’m as mad as hell and I’m not going to take this anymore!”
Ok, then I remember to hold my breath and count to 10. Well I counted to 10 and “I’m still mad as hell and I’m not going to take this anymore!” And I hope as you read today’s PAAD and think about OR waste and the inability to reprocess equipment for resuse will make you also want to stick your heads out the window (OR) and say “I’m mad as hell and I cant take this anymore”! Why can’t we reuse reprocessed anesthesia equipment? Why are single use items the norm? Indeed, in the history of the world has any patient developed an infection from a reused laryngoscope handle and its battery that was simply wiped clean (with alcohol or a chlorhexidine wipe)? Or for that matter has anyone developed a nosocomial infection from a reused, sterilized laryngoscope blade? I don’t think so and yet everyday, just about every one of us has been forced to use single use laryngoscope blades, handles and batteries. Just think about all those batteries going into landfill! This madness has got to stop…OK I’m holding my breath again and counting to 10 again…It isn’t helping…
Today’s PAAD by a guest reviewer, Dr. Shiu-Yi (“Emily”) Chen, a member of SPA’s Sustainability Special Interest Group and a faculty member at the University of California Irvine reviews a recent article in the ASA Monitor on this issue. The article isn’t that much longer than the PAAD so please take another 2-3 minutes to read the original. Indeed, there are several other articles on this topic in that issue of the Monitor as well, which Galaxy and his team will review over the next couple of weeks. Myron Yaster MD
Original article
Vukelich D. It's time for hospital workers to identify and eliminate roadblocks to reprocessing! ASA Monitor June 2023, Vol. 87, 20. https://doi.org/10.1097/01.ASM.0000938816.88765.15. Accessed 06/28/2023
In this month's ASA Monitor (June 2023), a series of articles summarize the causes of health care wastage with our mounting health care expenditure. One of them being the supply chain roadblock and reprocessing of single-use equipment. More specifically, the greenhouse gas (GHG) emission from US hospitals accounts for around 6% of all US emissions, 80% of these hospital-derived emissions come from the supply chain with purchased items being single-used only. Both the supply chain and equipment availability that make our job possible has exerted a significant impact on the environment and today’s healthcare economy.1
The direct relationship between climate change and public health continues to influence human health and diseases in many ways. The disturbances in earth biological and ecological systems have caused a rise in cardiovascular and pulmonary diseases. The U.N. Intergovernmental Panel on Climate Changes reported that the window of opportunity to reverse the damage from climate change is short and brief if human-caused global warming does not slow down by a couple tenths off a degree. Both the healthcare workers and the hospital have the obligation to first identity the causes of GHG emission and to mitigate the situation to prevent the cycle of climate change to human health stressors and subsequent hospitalization regardless of age, economic and geography.1, 2
Regulated reprocessing of single use medical devices is a proven example of sustainability. FDA regulated medical device reprocessing (MDR) helps hospitals reduce carbon emission by half when compared to using new device each time. Reprocessed medical devices cuts cost, waste, and greenhouse emission. The process also improves supply chain resiliency. With all said, barriers still exist to prevent the widespread adaptation of MDR. At the institutional level, staff training, managerial oversight and policy implantation are the causes for roadblocks. Does the MDR matches the hospital equipment priority? The misperception that reprocessed medical devices has decreased functionality needs to be demystified. At the federal level, the practice of “forced obsolescence” needs to be eliminated from manufacturer’s contractual clause even if the FDA approves such device appropriate for MDR. This is a manufacturer’s sabotage on the growth the reprocessing out of self-interest for profit maximization. Such practice will continue to stress the delicate supply chain and lead to soaring costs.3, 4
To curtail human-derived climate change and GHG emission, we need to recognize the circular economy involving environmentalism and medical device industry. We have the obligation to conserve resources and to reprocess FDA-regulated single-use device to reduce carbon footprint. We need to identify and to eliminate the roadblocks in MDR to help our planet and people.
From Myron: When Emily concluded that this is the time for us (“we”) to act she means YOU…everyone of you reading this PAAD. This is an ideal time to join SPA’s Sustainability Special Interest Group. Just go to SPA’s website or contact Diane Gordon, Liz Hansen, Carole Lin, or Galaxi Li. Send me your thoughts and I will post in a Friday Reader Response.
References
1. Vukelich D. It’s Time for Hospital Workers to Identify and Eliminate Roadblocks to Reprocessing. ASA Monitor June 2023, Vol. 87, 20. https://doi.org/10.1097/01.ASM.0000938816.88765.15
2. https://www.cdc.gov/climateandhealth/effects/default.htm
3. https://amdr.org/reprocessing-by-the-numbers/
4. Hennein R, Goddard E, Sherman J. Stakeholder perspectives on scaling up medical device reprocessing: A qualitative study. PLos One. 2022 Dec 30;17(12). DOI: 10.1371/journal.pone.0279808. PMID: 36584081. PMCID: PMC9803114