Letters

Healthcare Purchasing News, Sept, 2002

Down a tricky road

To the Editor,

Considering my position on why hospitals should be permitted to reprocess single-use devices without the FDA's intervention, (1) I feel compelled to comment on two articles in your June issue. First is the feature article "Waste management takes providers down a tricky road of rules and cost" (pg. 8); the second, "Disposable isolation gowns cheaper than reusables" (pg. 23).

Whereas the article on waste management focuses on the difficulties to be encountered in terms of complying with all the regulations associated with waste disposal, what is totally overlooked is the fact that the reprocessing of single-use medical devices is undoubtedly a proven way for eliminating a substantial amount of its generation.

It is more than likely that hospitals came to the realization that one of the ways to reduce the generation of waste was to reprocess those devices that were being identified by the manufacturers as 'single-use only.' But, of course, that alone was not the sole reason. There was also money to be saved. Amortizing the cost of an alleged single-use item over two uses automatically reduced its cost by 50 percent--less, of course, the reprocessing cost.

The healthcare providers' concern for the impact that disposing of medical waste has on the environment is nothing new. The fact of the matter is that the Oct 16, 1972, issue of Hospitals (Journal of the American Hospital Association) was dedicated to that very subject. Some of the issues addressed then are still on the table: ecological logic, new legislation and pollution control. What has been done about these concerns during this 30-year period? The community responded by establishing an entirely new administrative specialty dedicated to waste disposal management. Although this might not have proven to influence our society's Darwinian deep-rooted, habitual, throwaway mentality, solutions to the problems associated with today's incineration technology are being sought. For example, very recently the World Health Organization announced a contest to search for a cleaner, safer, low-cost technology to replace the current methods.

In the interim, while healthcare providers are faced with unprecedented levels of pressure to not only control but reduce costs, there is a question with which they could be confronted. Whereas reusing a single-use item a second time reduces its cost per use by 50 percent, how much can be saved with a reusable item that can be used some 50 times? Is it possible that there might be a situation in which the use of a single-use disposable item can prove to be more cost-effective than the reusable despite its having to be thrown away after one use and incinerated? The answer? Apparently so.

According to the experiences reported by the Robert Wood Johnson University Hospital in the second article, they were not only able to rid themselves of an array of problems associated with the distribution and availability of reusable isolation gowns, but by replacing them with a disposable product, they ended up on saving no less than $82,000 per year.

The fact of the matter is that they might even be able to save more.

It is noted that the frill-length gown they selected is made of a "latex-free polyethylene" material. Since it is known to be "liquid-proof" it provides the wearer with an impermeable baffler against bodily fluids." According to the Occupational Safety and Health Administration (OSHA) Final Rule on Occupational Exposure to Bloodborne Pathogens, (2) the level of protection that is to be provided by "Personal Protective Equipment" is considered "appropriate only if it does not permit blood or other potentially infectious materials to pass through ... under normal conditions of use and for the duration of time which the protective equipment will be used." This means that liquid-proof protection is only required in those situations in which the healthcare worker is engaged in a procedure in which they may come in contact with blood or other body fluids, i.e., in a trauma unit. It is only in those areas or departments where that possibility exists that the healthcare worker is to be provided with a garment affordi ng that liquid-proof protection. Although OSHA's mandate is universal in its application, it is not reasonable to believe that level of protection is necessary in every situation. Should it be determined that those situations are indeed the exception to the rule, the hospital's administration might want to consider introducing a less expensive type of gown for both isolation and other areas and save even more money.

Rather than viewed as being a rehash of the age-old reusable/disposable controversy, the purpose of this commentary is to emphasize the importance of viewing the selection of a product from the perspective of its overall cost-effectiveness: its function, its suitability for the purpose and, last but not least, its total cost. If the disposable gown has been found to satisfy those requirements as it has done at Robert Wood Johnson University Hospital, then its use is preferable.