Device reuse supports sustainability
Within a healthcare setting, providers can often choose from products that are either single-use or reusable. Single-use devices are either disposed of once used on a single patient or reprocessed through an FDA-regulated manufacturer.
Reusable medical devices fall into one of three categories, which determine the level of disinfection or sterilization needed between each use. The device is designated as either critical, semi-critical or noncritical.
“Critical and semi-critical devices require either high-level disinfection or sterilization,” explains Patrick Gordon, DNP, RN, CIC, Executive Director of Infection Prevention at Beth Israel Lahey Health. “During sterilization, any sort of viable living organism on the item is eradicated.”
Noncritical items, on the other hand, may be processed in other ways for reuse, such as laundering, where they are disinfected with bleach at a water temperature above 160 degrees Fahrenheit or by low-level disinfection with an Environmental Protection Agency-certified disinfectant product. In hospitals, cubicle curtains that divide rooms for privacy are one such item. “Undersheets in operating room settings can be single-use disposables, but you can also use a regular piece of linen instead,” Gordon adds. The same is true for mop heads—while there are disposable options, reusable, launderable microfiber mop heads are also available.
What’s the environmental impact?
The life cycle of a disposable product includes harvesting all the natural resources,
processing the material, creating the product and then distributing it to a hospital. Once used, it reaches end of life and is disposed of. “In essence, harvesting the resources through end of life is a linear pathway,” says Avery Palardy, MBA, MS, Executive Director of Climate Sustainability at Beth Israel Lahey Health.
For reusables, the life cycle is very different. “Once it enters into our healthcare system, we significantly reduce the need to repeatedly harvest resources and manufacture and distribute new products,” Palardy explains. “Instead, we are able to reuse that product after following the appropriate processing.”
Palardy has found that there are some common misconceptions about this process. A laundering facility uses lots of chemicals, energy and water, which some argue have a greater environ-mental impact than the harvesting of resources and creation of a new product.
“In some cases that may be true,” Palardy explains. “However, across most product categories, life cycle assessments consistently show that reusable products have a lower overall environmental footprint. While processing requires energy, water and chemicals, these impacts are typically far less than those associated with the linear life cycle of single-use supplies and equipment.”
Potential cost & resource savings
While device reuse helps the environment, it can also accrue cost savings for healthcare organizations. “In an operating room setting, an increased number of requests for disposable instruments have come through our new product request process,” shares Yan Hao, M.Ed., MHA, Executive Director of Value Analysis at Beth Israel Lahey Health. “A recent cross-functional collaboration involved bipolar forceps, and we prevented about a half million dollars of potential spend going to disposables by retaining the reusables.”
“There are labor savings on the cubicle curtain side, too,” adds April Palmquist, Director of Contract Management and Support Services at Beth Israel Lahey Health. “The EVS staff typically responsible for changing out those disposable curtains can be redeployed elsewhere in the hospital to attend to other needs.”
Scaling & standardizing reusables
As more disposables surface, Palardy challenges healthcare organizations to consider the options. “At BILH, we have been asking the question: ‘Why do we need to switch to disposables?’ If there is a lack of standardization across the system, with some hospitals using disposables while others are using reusables, we now consider if we can switch all locations to a reusable version of the same product.”
With a focus on scaling reusables as part of the move toward standardization, the Sustainability team, in partnership with their Infection Prevention peers, explored what processes were currently in place. This included reviewing processes that support proper disinfection before an item is returned to a hospital for reuse. The initiative started with privacy curtains and blood pressure cuffs, and the teams uncovered key findings, including some they were not expecting.
“For example, there was variability in practices and processes around the frequency of changing disposable curtains and the ability to track the last time the curtain was changed, which we are able to do with our reusable curtains,” Gordon shares.
Through further analysis of why some teams preferred various disposables, they learned these individuals found them to be more convenient and eliminated the issue around a missing product. “We really should not be trying to use products to solve a process issue,” Gordon says.
The journey ahead
To those skeptical of reusables, Palardy suggests at least making sure consideration is given to reusable alternatives as part of a health system’s vetting process. While the answer may still be “no” from a cost or infection-prevention standpoint, she believes this consideration is a step in the right direction. “Integrating environmental impact into product decision-making is essential to delivering high-value, sustainable care,” she explains. She also encourages healthcare colleagues to trust the sustainability professionals around them.
“Sometimes the disposable is the right option, depending on how much processing is required. The answers are not black and white; teams must break down silos and collaborate to come up with solutions that make the most sense for their facilities,” Hao adds.
ROLLING OUT REUSABLES
For organizations looking to standardize with reusable products, the team at Beth Israel Lahey Health suggests:
- Ensure collaboration & alignment. Before new disposables are adopted, set clear expectations & get consensus with the broader team.
- Leverage Value Analysis Committees for new product requests. Evaluate the necessity of new disposables replacing reusables. Ask questions & engage stakeholders from Sustainability, Infection Control & Value Analysis to determine if it is the standard product a hospital should be using.
- Communicate clearly & consistently. Get usage criteria from Infection Control for consistent use across hospitals or other healthcare settings.
- Consider other perspectives. Where there is data or literature to support a different approach, be open to making it part of the discussion.
Share your thoughts on device reuse with your peers within the HealthTrust Huddle, our online member community. You can also find sustainability resources on the Product Insights section of the HealthTrust Member Portal. Email sustainability@healthtrustpg.com with questions.
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