Recycling unused, opened sterile supplies - Clinical Innovations

AORN Journal, Jan, 2003 by Debra Dunn

As the debate about using reprocessed single-use devices continues, many hospitals and original equipment manufacturers, as well as the US Food and Drug Administration, agree that there is less risk involved in reprocessing supplies that never were used on a patient. (1) In 1991, Recovered Medical Equipment for the Developing World (REMEDY) was founded to collect and send opened but unused medical supplies to charitable organizations that then would deliver them to countries with limited resources.

The REMEDY program was founded by William H. Rosenblatt, MD, in conjunction with Yale-New Haven Hospital, New Haven, Conn. The not-for-profit, voluntary organization is composed of physicians, nurses, hospital volunteers, and others whose efforts are directed at recovering, decontaminating, sorting, counting, packing, and transferring discarded but useable surplus medical and surgical supplies to developing areas of the world. Items used in this effort include

* obsolete inventory,

* expired packages,

* products that were opened but not placed on the surgical field, and

* products that were opened and placed on the back table during surgery but were not used.

The volunteers from REMEDY distribute information packets, audiocassettes, computer disks, and videotapes that explain how to plan, develop, and implement the program. Their purpose is to provide educational literature on developing and implementing the program, as well as advice and encouragement for organizations that have similar goals. To date, 280 hospitals in the United States maintain a REMEDY program.

HOW IT WORKS

Operating room staff members at St Joseph's Wayne Hospital, Wayne, NJ, have implemented a program similar to REMEDY's. During the past five and one-half years, approximately nine charitable organizations and six staff physicians have picked up supplies from St Joseph's Wayne Hospital. These supplies were sent to Armenia, China, the Dominican Republic, India, Macao, Moldova, Nicaragua, Poland, Romania, Russia, Slovakia, South Africa, Syria, Turkey, Uzbeckistan, and Zimbabwe.

Departments involved in recycling include the OR for collection, the sterile processing department for ethylene oxide (EO) decontamination, and the general distribution center (ie, hospital inventory) for providing obsolete hospital inventory. In other institutions, the volunteer department may help with the sorting, counting, and packaging of items after they are decontaminated.

Collection at St Joseph's Wayne Hospital is a two-step process. Initially, all qualified disposable items--excluding sharps from the surgical field--that remain free from visible contamination (ie, tissue, blood, body fluids) are collected after a procedure is finished. The scrub person dons clean gloves and places these products into a centralized closed bin for future processing. When the bin is full, the products are placed into EO gas sterilization bags, closed with a rubber band, and delivered to the sterile processing department for EO decontamination. The person bagging these materials follows standard precautions by wearing a gown and gloves when bagging.

When released from sterile processing, the bags are opened and the items inside are sorted by category (eg, drapes, gowns, electrosurgical pencils, suction tubing, suction tips, laparotomy sponges, skin approximating staples), counted, and boxed. These items are declared contaminant-free, and a disclaimer note is placed into each box noting that the products were decontaminated with EO gas and these goods are offered by the facility for donation "as is" without any warranty. The second step of the project involves gathering opened supplies that were not on the back table (eg, procedure cancelled) and unopened obsolete or expired supplies or equipment. Both sets of items then are offered to various charitable organizations, which pick up the supplies from the hospital.

Numerous charitable organizations are willing and eager to pick up boxes of unused and decontaminated supplies from the OR and deliver them to developing countries. Additionally, many of these organizations work in conjunction with facilities that also provide surgical teams (eg, anesthesia care providers, surgeons, nurses) to perform necessary surgeries. Some charitable organizations St Joseph's Wayne Hospital has worked with in the past include

* Albert Schweitzer Institute for Humanities;

* Armenian General Benevolent Union;

* Carelift;

* Children of China, Pediatric;

* Healing the Children, Midatlantic;

* Peaceworks; and

* Project ORBIS International, Inc.

These organizations maintain offices near the hospital. Approximately twice each year on a rotating basis, these organizations pick up supplies from St Joseph's Wayne Hospital. It is important that the receiving charity be reliable and have expertise with overseas transportation, customs clearance, and supply distribution. Charitable organizations are responsible for ensuring that donations

* are germane for need,