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Vanderwee K, Demarré L, Malfait S, Kieckens E, De Waegemaeker P, Duprez V, Fraeyman N. How to choose between single-use and reusable medical materials for sustainable nursing: Methodological lessons learned from a national study. J Adv Nurs 2024. [PMID: 38812214 DOI: 10.1111/jan.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
AIM To demonstrate and reflect upon the methodological lessons by which healthcare organizations can address questions of environmental sustainability related to single-use healthcare materials. DESIGN A cross-sectional multi-centre study in hospitals was performed, followed by an exploratory analysis of the sustainability of commonly used healthcare materials. METHODS A hospital survey was conducted to collect the procurement data for single-use medical materials. Based on consumption and cost, five single-use medical materials with sustainable alternatives were selected using different reuse strategies. Single-use and reusable materials were assessed through an exploratory literature review and document study based on four parameters: environmental sustainability, safety, cost and efficiency. RESULTS A pragmatic method emerged from this study, providing healthcare facilities with tools to select environmentally sustainable alternatives to replace single-use options. First, an inventory of single-use medical materials consumed was collected. Next, single-use materials were prioritized for further study based on criteria such as cost, volume of the material, feasibility and input of stakeholders. We then analysed the prioritized single-use materials and their alternatives based on life cycle assessments or available information on their different life stages. Finally, we assessed safety, costs and efficiency related to the process following the use of the medical material. CONCLUSION This pragmatic method can guide healthcare institutions in making the most sustainable choices of medical materials and achieving sustainability goals within their institutions and nationwide. IMPACT Patient care involves a large consumption of single-use medical materials with considerable environmental impact. A pragmatic method was developed to guide healthcare institutions in making the most sustainable choices regarding the use of single-use healthcare materials. Healthcare institutions, ideally represented by a green team including nurses and other relevant professionals, can use this method to reduce the use of single-use medical materials, thereby yielding positive outcomes for the entire population. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | - Liesbet Demarré
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Simon Malfait
- Nursing Department, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Evelien Kieckens
- Environmental Department, Ghent University Hospital, Ghent, Belgium
| | | | - Veerle Duprez
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Norbert Fraeyman
- Nursing Department, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Ghorai RP, Kumar R. Reuse of Single-Use Devices in Endourology: A Review. J Endourol 2024; 38:68-76. [PMID: 37885229 DOI: 10.1089/end.2023.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Introduction: Single-use medical devices (SUDs) are labeled for single use only, but rising health care costs along with the absence of visible deterioration in the quality of SUDs after one use have led to their reprocessing and reuse. In the past, SUDs mainly consisted of equipment such as guidewires and catheters. However, SUDs have now expanded to flexible endoscopes and energy devices that are much more expensive. Reuse of such devices raises concerns of infection transmission, safety, and lack of effectiveness. We reviewed the disinfection process, cost benefits, potential harms, and legal status of the reuse of SUDs in endourology. Materials and Methods: PUBMED, Embase, and the Cochrane Library databases were searched for articles published between 1970 and March 2023 that reported the reuse of SUDs using the search terms "reuse"; "single-use device"; "disposable medical devices"; "reprocessing of single-use device"; "endourology"; and keywords related to cost, safety, sterilization, and legal status. Online resources were found using Google search engines. Articles on cost savings, device malfunction, disinfection, or legal status in different countries were reviewed. Results and Conclusions: Reusing SUDs has financial, environmental, and practical advantages. The potential savings on medical expenses is the most compelling argument for reprocessing disposable devices. Reusing medical equipment also contributes to the reduction of toxic biodegradable waste. However, there is a scarcity of data on the safety and efficacy of reused SUDs. For patient safety and to avoid complications, the practice must be regulated with established reprocessing standards.
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Affiliation(s)
- Rudra Prasad Ghorai
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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van den Berg D, Asker D, Awad TS, Lavielle N, Hatton BD. Mechanical deformation of elastomer medical devices can enable microbial surface colonization. Sci Rep 2023; 13:7691. [PMID: 37169828 PMCID: PMC10175502 DOI: 10.1038/s41598-023-34217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
Elastomers such as silicone are common in medical devices (catheters, prosthetic implants, endoscopes), but they remain prone to microbial colonization and biofilm infections. For the first time, our work shows that rates of microbial surface attachment to polydimethylsiloxane (PDMS) silicone can be significantly affected by mechanical deformation. For a section of bent commercial catheter tubing, bacteria (P. aeruginosa) show a strong preference for the 'convex' side compared to the 'concave' side, by a factor of 4.2. Further testing of cast PDMS materials in bending only showed a significant difference for samples that were manually wiped (damaged) beforehand (1.75 × 104 and 6.02 × 103 cells/mm2 on the convex and concave sides, respectively). We demonstrate that surface microcracks in elastomers are opened under tensile stress (convex bending) to become 'activated' as sites for microbial colonization. This work demonstrates that the high elastic limit of elastomers enables these microcracks to reversibly open and close, as 'dynamic defects'. Commercial catheters have relatively high surface roughness inherent to manufacturing, but we show that even manual wiping of newly-cast PDMS is sufficient to generate surface microcracks. We consider the implication for medical devices that feature sustained, surgical, or cyclic deformation, in which localized tensile conditions may expose these surface defects to opportunistic microbes. As a result, our work showcases serious potential problems in the widespread usage and development of elastomers in medical devices.
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Affiliation(s)
| | - Dalal Asker
- Department of Materials Science and Engineering, University of Toronto, Toronto, Canada
- Food Science & Technology Department, Alexandria University, Alexandria, Egypt
| | - Tarek S Awad
- Department of Materials Science and Engineering, University of Toronto, Toronto, Canada
| | - Nicolas Lavielle
- Physique et Mécanique des Milieux Hétérogènes, CNRS, ESPCI, PSL Research University, Sorbonne Université, Sorbonne Paris Cité, 75005, Paris, France
| | - Benjamin D Hatton
- Department of Materials Science and Engineering, University of Toronto, Toronto, Canada.
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada.
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Yauger CY, Waite LK, Baker K, Mallory A, Attilio LP, Stucky LC, Stone MJ, Ioset MN, Johnson D. Durability and disinfection of single-use endotracheal tubes following exposure to commonly available medical disinfecting compounds. Nurs Outlook 2022; 70:S127-S135. [PMID: 36585059 DOI: 10.1016/j.outlook.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Reusing single-use medical supplies offers a capability enhancement during massive casualty incidents when resupply of medical supplies is unavailable in times of national health care crises. This pilot study determined the feasibility of disinfection of endotracheal tubes with commonly used chemical disinfecting agents. METHODS Endotracheal tubes (ETTs) were subjected to either CaviCide, Neutral Disinfectant Cleaner, Cidex, or saline according to the manufacturer's recommended disinfection contact times. Alterations to the polyvinyl chloride (PVC) integrity by disinfecting agents were determined by volume/pressure measurements within the ETT cuff. To test the disinfection rate, ETTs were inoculated with Staphylococcus Aureus and subjected to experimental disinfection protocol. FINDINGS There were no significant alterations to ETT tracheal cuff function and mixed results in disinfection among ETTs. ETTs bacterial culture data presented possible contamination among the groups. DISCUSSION These data support the feasibility of single-use ETT reuse as a last resort while making every attempt and effort to follow established protocols to minimize harm to the patient.
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Affiliation(s)
- Col Young Yauger
- United States Army Graduate Program in Anesthesia Nursing, Joint Base, San Antonio, TX.
| | - Lt Kyle Waite
- Navy Medicine Training and Support Center, Joint Base San Antonio, San Antonio, TX
| | - Kimberly Baker
- Science & Technology 59th Medical Wing, JBSA Lackland Air Force Base, San Antonio, TX
| | - Amber Mallory
- Science & Technology 59th Medical Wing, JBSA Lackland Air Force Base, San Antonio, TX
| | - Ltc Peter Attilio
- Science & Technology 59th Medical Wing, JBSA Lackland Air Force Base, San Antonio, TX
| | - Ltc Christopher Stucky
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Germany
| | - Maj Jessica Stone
- United States Army Graduate Program in Anesthesia Nursing, Joint Base, San Antonio, TX
| | - Maj Nicole Ioset
- United States Army Graduate Program in Anesthesia Nursing, Joint Base, San Antonio, TX
| | - Don Johnson
- United States Army Graduate Program in Anesthesia Nursing, Joint Base, San Antonio, TX
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Bayrak T, Soylu SI. Reprocessing of single use medical devices: A new proposal for a regulation. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Costa EA, Costa E. Dispositivos de uso único: políticas de regulação de reuso e implicações para a saúde coletiva. SAÚDE EM DEBATE 2021. [DOI: 10.1590/0103-1104202113025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O reuso de dispositivos médicos de uso único implica segurança em saúde. Este estudo analisa sistemas regulatórios de reuso de produtos médicos de uso único em âmbito internacional. Trata-se de revisão integrativa, com descritores específicos, sem restrição de ano da publicação. A busca dos dados, entre outubro e dezembro de 2017, incluiu 23 estudos. As políticas de reuso desses produtos variam entre países, com normas legitimando essas práticas, como a norte-americana e a alemã, normas restritivas e regulações inexistentes em nível nacional, como no Canadá, no Japão e na Europa. Essas políticas centram-se na regulação pré-comercialização, estruturam-se na classificação dos produtos, com questões relacionadas ao rótulo dos produtos, se multiuso ou de uso único, ponto-chave do dilema desse reuso. Este estudo aponta a necessidade de reestruturação das políticas de reuso de produtos de uso único quanto à classificação desses dispositivos, bem como à adoção de mecanismos para clarificação do rótulo desses produtos. Ressalta os condicionantes internos e externos que envolvem o desenvolvimento das políticas de saúde e o papel do Estado na preservação dos direitos da saúde de seus cidadãos, em detrimento dos grupos de interesses privados e dotados de fortes recursos de poder, como a indústria de produtos médicos.
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Affiliation(s)
| | - Ediná Costa
- Universidade Federal da Bahia (UFBA), Brasil
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Naoum P, Palioura S, Naoum V, Nomikos N, Bachtalia K, Zisis K, Athanasakis K, Kyriopoulos J. Cost-Benefit Analysis of Single versus Repeated Use of Single-Use Devices in Cataract Surgery. Clin Ophthalmol 2021; 15:1491-1501. [PMID: 33880008 PMCID: PMC8052126 DOI: 10.2147/opth.s292849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To estimate the net cost effect associated with the real-world practice of repeated use of designated single-use medical devices (SUDs) versus their proper single use in cataract surgery in Greece. DESIGN A cost-benefit analysis model was constructed in the form of a decision tree. METHODS A digital expert panel was assembled in order to estimate the probabilities of intraoperative and postoperative complications associated with single and repeated use of SUDs. Unit costs for the management of each complication were obtained from the official Greek bulletins. A Monte Carlo-type sensitivity analysis was performed to assess the robustness of the results. RESULTS Based on the probabilities of complications attained from the expert panel, repeated use of SUDs is associated with a higher chance of complications compared to single use, which results in higher cost of complication management. Under the healthcare sector perspective, the total expected cost per cataract surgery is 1,403.98€ (1,244.20€ the initial cost of cataract surgery plus 159.78€ the cost of adverse events) in the case of single use, while for repeated use the total cost is 1,486.29€ (1,146.86€ + 339.43€, respectively) and, thus, repeated use of SUDs in cataract surgery results in 82.31€ higher expected cost per patient compared to their single use. Moreover, the societal perspective analysis indicated even higher additional costs in the case of SUD reuse (108.24€). CONCLUSION Repeated use of SUDs in cataract surgery is not appropriate, it jeopardizes patient safety and carries a legal liability for the reuser. The present study, which is the first to attach a monetary value to the common yet questionable practice of SUD reuse, shows that it is not cost beneficial. Therefore, it is expected that the results will have implications in policy formulations to improve the delivery of cataract healthcare.
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Affiliation(s)
| | | | | | | | | | | | - Kostas Athanasakis
- Institute for Health Economics, Athens, Greece
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
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Azi LMTDA, Fonseca NM, Linard LG. SBA 2020: Regional anesthesia safety recommendations update. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32636024 PMCID: PMC9373527 DOI: 10.1016/j.bjane.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of the Brazilian Society of Anesthesiology (SBA)’s Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.
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Affiliation(s)
- Liana Maria Tôrres de Araújo Azi
- Universidade Federal da Bahia (UFBA), Departamento de Anestesiologia e Cirurgia, Salvador, BA, Brazil; Hospital Universitário Professor Edgard Santos, Centro de Ensino e Treinamento em Anestesiologia, Salvador, BA, Brazil; Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil.
| | - Neuber Martins Fonseca
- Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Disciplina de Anestesiologia, Uberlândia, MG, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Centro de Ensino e Treinamento em Anestesiologia, Uberlândia, MG, Brazil; Coordinator of the Comitê de Estudo de Equipamentos Respiratórios e de Anestesiologia da ABNT, and Delegate and representative of the SBA Board at the Technical Committee 121/ISO - Anesthetic and Respiratory Equipment, Uberlândia, MG, Brazil
| | - Livia Gurgel Linard
- Hospital Geral do Estado 2 and of Hospital Roberto Santos, Salvador, BA, Brazil
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Azi LMTDA, Fonseca NM, Linard LG. [SBA 2020: Regional anesthesia safety recommendations update]. Rev Bras Anestesiol 2020; 70:398-418. [PMID: 32636024 DOI: 10.1016/j.bjan.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/26/2020] [Accepted: 02/08/2020] [Indexed: 12/24/2022] Open
Abstract
The purpose of the Brazilian Society of Anesthesiology's (SBA) Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.
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Affiliation(s)
- Liana Maria Tôrres de Araújo Azi
- Universidade Federal da Bahia (UFBA), Departamento de Anestesiologia e Cirurgia, Salvador, BA, Brazil; Hospital Universitário Professor Edgard Santos, Centro de Ensino e Treinamento em Anestesiologia, Salvador, BA, Brazil; Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil.
| | - Neuber Martins Fonseca
- Comissão de Norma Técnicas da Sociedade Brasileira de Anestesiologia (SBA), Salvador, BA, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Disciplina de Anestesiologia, Uberlândia, MG, Brazil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Centro de Ensino e Treinamento em Anestesiologia, Uberlândia, MG, Brazil; Coordinator of the Comitê de Estudo de Equipamentos Respiratórios e de Anestesiologia da ABNT, and Delegate and representative of the SBA Board at the Technical Committee 121/ISO - Anesthetic and Respiratory Equipment, Uberlândia, MG, Brazil
| | - Livia Gurgel Linard
- Hospital Geral do Estado 2 and of Hospital Roberto Santos, Salvador, BA, Brazil
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Wang D, Wu J. Reprocessing and reuse of single-use medical devices in China: a pilot survey. BMC Public Health 2019; 19:461. [PMID: 31039773 PMCID: PMC6492401 DOI: 10.1186/s12889-019-6835-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/15/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In China, reprocessing and reuse of single-use medical devices (SUDs) are banned. However, the actual situation has not been reported so far. The study aims to clarify the perceptions and concerns of various sectors of the community on the reuse of SUDs, and whether such practice exists. In addition, we are also wondering how acceptable the respondents are on this matter. METHODS A cross-sectional study based on a national survey which was conducted on the professional online questionnaire survey platform ( www.wjx.cn ) from July 26 to August 4, 2015. We analyzed the data according to the work fields, sex, age, education level, professional background and participants' answers to 49 other questions. RESULTS Five hundred forty-four nationwide respondents belong to nine different work fields. In general, participants had positive attitudes towards the reprocessing and reuse of SUDs. However, many respondents doubted the hygienic and functional safety of the reprocessed SUDs. They also tended to think that the reuse of SUDs should have lower prices and more technical training as well as patient advocacy. Further analysis demonstrated the work fields, education level and professional background of respondents were statistically associated with their responses to certain questions. CONCLUSIONS The research indicated that although the reuse of SUDs is prohibited legally in China, there were extensive reprocessing and reuse in hospitals. Most responses tended to accept reprocessed SUDs if safety and low prices were guaranteed. These existing contradictions and the lack of relevant research led to policy makers in China will confront numerous challenges in building and improving this use system of medical devices to meet escalating demands of social sectors.
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Affiliation(s)
- Duojin Wang
- Shanghai Engineering Research Center of Assistive Devices/School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Jungong Road 516, Shanghai, 200093 China
| | - Jing Wu
- School of Economics & Management, Tongji University, Siping Road 1500, Shanghai, 200092 China
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Ordway A, Pitonyak JS, Johnson KL. Durable medical equipment reuse and recycling: uncovering hidden opportunities for reducing medical waste. Disabil Rehabil Assist Technol 2018; 15:21-28. [DOI: 10.1080/17483107.2018.1508516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Anne Ordway
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Kurt L. Johnson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Garay OU, Garcia Elorrio E, Rodríguez V, Spira C, Augustovski F, Pichon-Riviere A. Single-Use Devices in Argentina: Cost Comparison Analysis of a “Re-Use” versus a “Single-Use” Policy for Trocars, Endocutters, Linear Cutters, and Harmonic Scalpels. Value Health Reg Issues 2017; 14:89-95. [DOI: 10.1016/j.vhri.2017.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/19/2016] [Accepted: 04/03/2017] [Indexed: 10/18/2022]
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Transcatheter interventions in congenital heart diseases using reusable cardiovascular catheters and devices. Indian Heart J 2017; 69:515-516. [PMID: 28822521 PMCID: PMC5560886 DOI: 10.1016/j.ihj.2017.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/07/2017] [Accepted: 07/04/2017] [Indexed: 11/22/2022] Open
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Gupta DK, Bisht A, Batra P, Mathur P, Mahapatra AK. A cost effectiveness based safety and efficacy study of resterilized intra-parenchymal catheter based intracranial pressure monitoring in developing world. Asian J Neurosurg 2016; 11:416-420. [PMID: 27695548 PMCID: PMC4974969 DOI: 10.4103/1793-5482.165785] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The management of traumatic brain injury (TBI) aims to maintain the normal cerebral perfusion in spite of the mass lesions that may occur (haematoma, contusion, and oedema). The monitoring of the intracranial pressure (ICP) is a step in that direction. The intra-parenchymal catheters have the lowest incidence of infection compared to intra-ventricular/subdural catheters with reliable and accurate pressure recordings. The major disadvantage of the intra-parenchymal catheters is the cost, especially in developing nations. Hypothesis: Resterilized intra-parenchymal strain gauge catheters can be used safely for ICP monitoring without any added risk of meningitis. The reusage of catheters can bring down the costs. Resterilized catheters/equipment have been approved for usage in cardiac usage, but such study on ICP catheters has not been carried out so far in any part of the world. Methodology: A total of 100 consecutive cases of severe TBI receiving ICP monitoring at a level 1 trauma center of a developing nation were prospectively studied (34 cases had fresh catheters, and 66 had resterilized [using ethylene oxide] catheters). Observations: The use of reused resterilized catheters was not associated with increased incidence of meningitis or fever (the surrogate marker for infection in this study). Also, there was concordance between the pressure recording of reused catheters and operative finding/subsequent computed tomography scans. These catheters after sterilization could be reused 2–4 times and reliably recorded the ICP (insignificant drift) with no increase in the incidence of meningitis. Conclusions: Usage of resterilized intra-parenchymal ICP catheters is feasible, safe, efficacious, and cost effective and brings down the cost of monitoring significantly.
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Affiliation(s)
- Deepak Kumar Gupta
- Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
| | - Ajay Bisht
- Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
| | - Priyam Batra
- Department of Microbiology, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
| | - Purva Mathur
- Department of Microbiology, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
| | - Ashok Kumar Mahapatra
- Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
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Şoşdean R, Mornoş C, Enache B, Macarie RI, Ianoş R, Ştefea AM, Pescariu S. Safety and feasibility of biventricular devices reuse in general and elderly population--a single-center retrospective cohort study. Clin Interv Aging 2015; 10:1311-8. [PMID: 26316726 PMCID: PMC4541561 DOI: 10.2147/cia.s88805] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Introduction Cardiac resynchronization therapy (CRT) is known to have very important beneficial effects on heart failure patients. Unfortunately, biventricular implantable cardiac devices (CRT devices), through which this therapy is implemented, are very expensive and sometimes hard to achieve, especially in underdeveloped/developing economies, making this an important problem of public health. As a possible solution, CRT reuse is of great interest nowadays, but unlike simple devices, data in the literature are scarce about biventricular device reuse. Aim To address safety concerns, we aimed to analyze infection burden in the general and elderly population and also early battery depletion and generator malfunction of resterilized biventricular devices compared to new devices. Methods A cohort of 261 CRT patients (286 devices), who underwent implantation between 2000 and 2014, was retrospectively analyzed. The study group included 115 patients and 127 resterilized devices, that was divided into a subgroup of 69 elderly patients (≥60 years) and 74 devices and a subgroup of 47 younger patients (<60 years) and 53 devices, and the control group included 146 patients and 159 new devices. The groups were compared using a multivariate logistic regression model. Results A number of 12 (4.2%) infectious complications were encountered, five (3.9%) in the study group and seven (4.4%) in the control group (odds ratio, 2.83 [0.59–13.44], P=0.189), one (1.3%) in the elderly and four (7.5%) in the younger subgroup (odds ratio, 3.80 [0.36–40.30], P=0.266), with no statistically significant difference between them. There was only one case of early battery depletion, after 17 months, in one study group patient. No generator malfunction was detected. Conclusion Reuse of biventricular cardiac implantable electronics seems feasible and safe in both the general population and the elderly population, and it could be a promising alternative when new devices cannot be obtained in a safe period of time.
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Affiliation(s)
- Raluca Şoşdean
- Department of Cardiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania ; Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania
| | - Cristian Mornoş
- Department of Cardiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania ; Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania
| | - Bogdan Enache
- Department of Cardiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania ; Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania
| | - Răzvan I Macarie
- Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania
| | - Raluca Ianoş
- Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania
| | - Ana-Maria Ştefea
- Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania
| | - Sorin Pescariu
- Department of Cardiology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania ; Cardiology Clinic, Institute of Cardiovascular Medicine, Timişoara, Romania
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Jama ZV, Chin A, Badri M, Mayosi BM. Performance of re-used pacemakers and implantable cardioverter defibrillators compared with new devices at Groote Schuur Hospital in Cape Town, South Africa. Cardiovasc J Afr 2015; 26:181-7. [PMID: 26407220 PMCID: PMC4683290 DOI: 10.5830/cvja-2015-048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/12/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Little is known about the performance of re-used pacemakers and implantable cardioverter defibrillators (ICDs) in Africa. We sought to compare the risk of infection and the rate of malfunction of re-used pacemakers and ICDs with new devices implanted at Groote Schuur Hospital in Cape Town, South Africa. METHODS This was a retrospective case comparison study of the performance of re-used pacemakers and ICDs in comparison with new devices implanted at Groote Schuur Hospital over a 10-year period. The outcomes were incidence of device infection, device malfunction, early battery depletion, and device removal due to infection, malfunction, or early battery depletion. RESULTS Data for 126 devices implanted in 126 patients between 2003 and 2013 were analysed, of which 102 (81%) were pacemakers (51 re-used and 51 new) and 24 (19%) were ICDs (12 re-used and 12 new). There was no device infection, malfunction, early battery depletion or device removal in either the re-used or new pacemaker groups over the median follow up of 15.1 months [interquartile range (IQR), 1.3-36.24 months] for the re-used pacemakers, and 55.8 months (IQR, 20.3-77.8 months) for the new pacemakers. In the ICD group, no device infection occurred over a median follow up of 35.9 months (IQR, 17.0-70.9 months) for the re-used ICDs and 45.7 months (IQR, 37.6-53.7 months) for the new ICDs. One device delivered inappropriate shocks, which resolved without intervention and with no harm to the patient. This re-used ICD subsequently needed generator replacement 14 months later. In both the pacemaker and ICD groups, there were no procedure-non-related infections documented for the respective follow-up periods. CONCLUSION No significant differences were found in performance between re-used and new pacemakers and ICDs with regard to infection rates, device malfunction, battery life and device removal for complications. Pacemaker and ICD re-use is feasible and safe and is a viable option for patients with bradyarrhythmias and tachyarrthythmias.
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Affiliation(s)
- Zimasa V Jama
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.
| | - Ashley Chin
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
| | - Motasim Badri
- College of Medicine, King Saudi Bin, Abdulaziz University for Medical Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Bongani M Mayosi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
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Safety and feasibility of laparoscopic colo-rectal surgery for cancer at a tertiary center in a developing country: Egypt as an example. J Egypt Natl Canc Inst 2015; 27:91-5. [PMID: 25921235 DOI: 10.1016/j.jnci.2015.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/19/2015] [Accepted: 03/23/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Laparoscopic colectomy has been shown to have significant short- and long-term benefits compared to open approach. The incorporation of laparoscopy in developing countries is challenging, due to the high costs of equipment and lack of expertise. The aim of this study was to evaluate the safety and feasibility of laparoscopic colorectal surgery for cancer that could be performed in developing countries under different circumstances in developed countries. METHODS Thirty-seven patients (23 males and 14 females) with colorectal cancer with a median age of 46 years (39-72) have been enrolled for laparoscopic colo-rectal surgery in a tertiary center in Egypt (South Egypt Cancer Institute) with the trend of reuse of some disposable laparoscopic instruments. RESULTS The median operative time was 130 min (95-195 min). The median estimated blood loss was 70 ml (30-90 ml). No major intra-operative complications have been encountered. Two cases (5.5%) have been converted because of local advancement (one case) and bleeding with unavailability of vessel sealing device at that time (one case). The median time for passing flatus after surgery was 36 h (12-72 h). The median hospital stay was 4.8 days (4-7 days). The peri-operative period passed without events. Pathologic outcome revealed that the median number of retrieved lymph nodes was 14 (range 9-23 lymph node) and all cases had free surgical margin. CONCLUSION Laparoscopic colorectal surgery for cancer in developing countries could be safe and feasible. Safe reuse of disposable expensive parts of some laparoscopic instruments could help in propagation of this technique in developing countries.
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Cruz M, Mahillo-Fernandez I, Rábano A, Siden A, Calero M, Laursen H, Mølbak K, Almazán J, de Pedro-Cuesta J. Late-in-life surgery associated with Creutzfeldt-Jakob disease: a methodological outline for evidence-based guidance. Emerg Themes Epidemiol 2013; 10:5. [PMID: 23701872 PMCID: PMC3680217 DOI: 10.1186/1742-7622-10-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/09/2013] [Indexed: 01/06/2023] Open
Abstract
Background There is increasing epidemiological evidence of etiological links between general surgery and sporadic Creutzfeldt-Jakob disease (sCJD) with long incubation periods. The purpose of this study was to identify specific surgical procedures potentially associated with sCJD to be targeted for preventive presurgical-intervention guidance. Results We propose a three-step clinical guidance outline where surgical procedures associated with sCJD clinical onset – potentially more contaminant - are taken into account. Data on hospital discharges and surgical procedures were obtained from Danish and Swedish national in-patient hospital registries for 167 sCJD cases, onset 1987–2003, and for 835 matched and 2,224 unmatched population controls. Surgery was allocated to different life-time periods as previously reported, and frequencies were compared using logistic regression analysis. In the year preceding clinical onset, persons with sCJD underwent a statistically significant higher number of minor surgical interventions (OR (95% CI): 17.50 (3.64-84.24)), transluminal endoscopies (OR: 2.73 (1.01–7.37)) and gastrointestinal operations (OR: 3.51 (1.21–10.19)) compared to matched controls. Surgical discharges clustered towards clinical onset. These differences increased during the clinical period, with statistically significant higher frequencies for both endoscopies and minor surgery (OR: 13.91 (5.87-32.95), and for main surgical procedures (OR: 2.10 (1.00-4.39)), particularly gastrointestinal surgery (OR: 6.00 (1.83-19.66)), and surgery contacting skeletal muscle. Comparisons with unmatched controls yielded similar results for neurosurgery in the clinical period (OR: 19.40 (2.22-168.34)). Conclusions These results suggest that some types of surgical procedures are associated with sCJD, after clinical onset or particularly just before onset. Selective planning of such surgery to minimize instrument/device contamination or quarantining might be feasible. Conditional to progress in sCJD etiological research, results are relevant for guidance development.
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Affiliation(s)
- Mabel Cruz
- Department of Applied Epidemiology, National Center for Epidemiology, Carlos III Institute of Health, C/ Sinesio Delgado 6, Madrid 28029, Spain.
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Nava S, Morales JL, Márquez MF, Barrera F, Gómez J, Colín L, Brugada J, Iturralde P. Reuse of pacemakers: comparison of short and long-term performance. Circulation 2013; 127:1177-83. [PMID: 23426104 DOI: 10.1161/circulationaha.113.001584] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In developing economies, there are patients in whom pacemaker implantation is delayed because they cannot afford one. Reused devices have been a solution. To address concerns about safety, a cohort of consecutive patients implanted with a reused pacemaker was compared with a control group. METHODS AND RESULTS A cohort of 603 consecutive patients from 2000 to 2010 was studied in an ambispective noninferiority study. The study group patients (n=307) received resterilized pacemakers, and the control group patients (n=296) received a new pacemaker. A combined end point of 3 major outcomes-unexpected battery depletion, infection, and device dysfunction-was analyzed. A total of 85 pacemakers had to be explanted, 31 in the control group (10.5%) and 54 in the study group (17.6%; relative risk, 1.68; 95% confidence interval, 1.1-2.5; P=0.02). Forty-three reached the primary end point, 16 in the control group (5.5%) and 27 in the study group (7.2%; relative risk, 1.3; 95% confidence interval, 0.70-2.45; P=0.794). In terms of individual outcomes, 5 new pacemakers (1.7%) and 11 resterilized pacemakers (3.6%) had unexpected battery depletion (relative risk, 2.12; 95% confidence interval, 0.75-6; P=0.116); 3.7% new pacemakers and 3.2% reused pacemakers had a procedure-related infection (relative risk, 0.87; 95% confidence interval, 0.38-2.03; P=0.46); and 1 pacemaker in the study group malfunctioned. CONCLUSIONS Pacemaker reuse is feasible and safe and is a viable option for patient with bradyarrhythmias. Other than the expected shorter battery life, reuse of pacemaker generators is not inferior to the use of new devices.
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Affiliation(s)
- Santiago Nava
- Instituto Nacional de Cardiología "Ignacio Chávez, Department of Electrocardiology, Juan Badiano 1 Col Sección XVI, Tlalpan 14080, Mexico City, Mexico.
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Anderson O, Brodie A, Vincent CA, Hanna GB. A Systematic Proactive Risk Assessment of Hazards in Surgical Wards. Ann Surg 2012; 255:1086-92. [DOI: 10.1097/sla.0b013e31824f5f36] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shuman EK, Chenoweth CE. Reuse of medical devices: implications for infection control. Infect Dis Clin North Am 2012; 26:165-72. [PMID: 22284382 DOI: 10.1016/j.idc.2011.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reuse of both single-use and multiuse medical devices is a common practice and can result in transmission of infection when appropriate sterilization or reprocessing does not occur. Reuse of single-use devices can be problematic because there are no clear standards for reprocessing, although data regarding adverse outcomes are limited. Single-use devices are commonly reused, appropriately or inappropriately, in resource-limited settings because of cost constraints. Reuse of medical devices raises important legal and ethical questions.
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Affiliation(s)
- Emily K Shuman
- Division of Infectious Diseases, University of Michigan, 3119 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5378, USA
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Costa EAM, Costa EA, Graziano KU, Padoveze MC. [Medical device reprocessing: a regulatory model proposal for Brazilian hospitals]. Rev Esc Enferm USP 2012; 45:1459-65. [PMID: 22241207 DOI: 10.1590/s0080-62342011000600026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 03/15/2011] [Indexed: 11/22/2022] Open
Abstract
Medical device reprocessing is extremely important and complex, thus requiring both the operational skills for its implementation and the technical qualification of the professionals involved in the activity. The typical issues of medical device reprocessing involve technical, economical and regulatory aspects when involving either the so-called reusable articles or those considered as for a single use. The objective of the present study is to propose a new regulatory model for medical device reprocessing in Brazil that would, on the one hand, satisfy the requirements for quality and safety, as recommended in the literature and, on the other hand, prove to be operational under the conditions prevailing in Brazilian hospitals. The elaboration of the present normative proposal was based on the Consensus Conference technique among specialists in the area. Guided by the contribution of these specialists, a proposal is put forth of a regulatory model for reprocessing medical products, so as to address some previously identified gaps in the normative body currently used in Brazil.
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Fernandes CR, Fonseca NM, Rosa DM, Simões CM, Duarte NMDC. Brazilian Society of Anesthesiology Recommendations for Safety in Regional Anesthesia. Rev Bras Anestesiol 2011; 61:668-94, 366-81. [DOI: 10.1016/s0034-7094(11)70077-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Razak S, Yee R. Medical device reuse: The return of Robin Hood? Heart Rhythm 2010; 7:1628-9. [DOI: 10.1016/j.hrthm.2010.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Indexed: 11/17/2022]
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What is the use? An international look at reuse of single-use medical devices. Int J Hyg Environ Health 2010; 213:302-7. [PMID: 20471316 DOI: 10.1016/j.ijheh.2010.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 04/13/2010] [Accepted: 04/13/2010] [Indexed: 11/23/2022]
Abstract
Reuse of single-use devices is common in most countries worldwide. We provide an overview of the issue from an international perspective. In many developing and transitional countries reuse of cheap single-use devices (needles, syringes, surgical gloves) is common leading to large numbers of unsafe interventions, specifically injections and, as a consequence, infection with hepatitis B, C or HIV. There are various reasons for reuse: limited resources, insufficient knowledge of healthcare workers and the belief of patients that injection is more beneficial than oral medication. Reuse of cheap single-use devices should cease and both medical staff and the public should be informed about potential safety risks associated with injection. In developed countries, reuse of single-use items is less common but may include expensive technical products. Reuse is regulated in many countries (e.g. US, Canada, some European countries) demanding ethical and legal considerations, high standards of reprocessing and training of staff, risk assessment, management and validation of reprocessing. Well regulated reprocessing can decrease the number of single-use devices reprocessed. In developing as well as developed countries, a decision to reprocess single-use devices should only be made after a critical reflection of advantages and disadvantages.
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Abstract
Pragmatism
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Affiliation(s)
- D C Winter
- Institute for Clinical Outcomes Research and Education (iCORE), St Vincent's University Hospital and University College Dublin, Dublin, Ireland
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