Re: Single Use vs Reusable Pt Equipment

09/01/2014 at 11:34 am #70706 Quote

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Michael Wishart

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I will chip in as well. The biggest issue I have had over the years, and it still applies today, is the economic ‘bean-counter’ argument where the cost of consumables vs the cost of reusable is a tangible budget line, whereas the costs associated with prevention of infections is not. So when we talk about moving to disposable tourniquets, for example, everyone agrees that the infection control principles are good, but the ‘bean-counter’ mentality sees how much it will cost vs what reusable tourniquets ‘cost’, and it doesn’t get approved. Budget lines seem pretty much fixed in the ‘bean-counter’ mentality, and when a department manager sees an increase in expenditure but cannot easily see the savings in THEIR budget, then they stop supporting this even if they like the principle. I have seen it many times.

What is needed, I believe, similar to what we need in Australia for safety devices in sharps, is some form of mandatory requirement or penalties if you don’t use them. Currently there is very little from a penalty perspective to make administrators work very hard to prevent infections (like a financial penalty), although these seem to be more commonly increasing. A major change in funding methodology and accountability for infections will, I think, lead to greater use of disposables. The US health system is what I see as an example of this, flawed and damaged as it is.

Another problem is actual evidence related to infection reduction for specific disposables (eg tourniquets). Who is to say to giving all the medical staff disposable ties would have more impact on MRSA acquisition rates? Evidence related to bacterial reduction does not automatically equate with infection risk reduction; we all know that. The difficulty in saying definitely that doing x will result in y will always make the ‘bean-counter’ mentality the most prevalent, I think.

Just my (cynical) views as another ‘oldie. 🙂

Cheers
Michael

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside,Qld4032
t: (07) 3326 3068 | f: (07) 3607 2226
e:Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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—–Original Message—–

Thanks Irene and Terrie
Whilst I appreciate Terrie’s position coming from his role with a provider of reusable waste equipment my question was more specifically about equipment used on patients for clinical care so things like BP cuffs, ECG leads and tourniquets. The various responses are interesting and please keep them coming as debate and expression are good for us as is an appreciation for the past (and yes I qualify and feel “oldie” as well 🙂 Cheers Cath

Regards
Cath

Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd

Adjunct Professor
Griffith University, School of Nursing and Midwifery
http://www.infectioncontrolplus.com.au

—–Original Message—–

Hi all,
as a fellow “oldie” I agree with Terry’s assessment of the trends over the years. I also support the final point about the issues involved in the decision making process. What has always puzzled me is how to accurately measure the environmental impact of either disposable or re-usable items?

Irene Wilkinson
Manager, Infection Control Service,
Communicable Disease Control Branch
SA Health
11 Hindmarsh Square,
Adelaide SA 5000
________________________________________

Hi Cath,
I had not heard of a movement back to single use items so I will be interested to hear members’ responses on this topic. For oldies like me it has been interesting to see the disposable/reusable “cycle” over the decades.

* in the 60’s we reused needles, glass syringes, gowns, etc, to reduce procurement costs;

* in the 70’s the cost of labour to process reusables (and modern technology enabling economic production of disposables) moved us to disposables;

* In the 80’s and 90’s waste disposal costs together with environmental impact of disposables, caused many to move to reusables again;

* Now with staff shortages, in-house processing of reusables is being re-examined (NB. processing by external contractors can still be economical, e.g. reprocessing single-use medical devices saves USA hospitals $300m annually.
As you point out, there have been relatively few evidence-based articles implicating disease transmission with either protocol.
The decision to use disposables or reusables must be evidence-based encompassing patient and staff safety, labour costs, procurement costs, and environmental impact. I look forward to members’ comments

Best regards, Terry

Terry Grimmond FASM, BAgrSc, GrDpAdEd
Consultant Microbiologist
Grimmond and Associates
Ph/Fx (NZ): +64 7 856 4042
Mob (NZ): +64 274 365 140
E: tg@gandassoc.com
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Happy new year all

As you may know there’s a subtle movement in Australia towards more widespread adoption of single-use items such as venepuncture tourniquets, lower limb surgical tourniquets, BP cuffs and ECG leads. Tom Gottlieb recently did some elegant research on venepuncture tourniquets and AT ACIPC 2013 Karen Vickery presented new perspectives on biofilm on reusable equipment. Single-use items have been adopted widely in the US for some years and recommendations to that effect are included in many Standards published by relevant professional associations eg AORN.

Whilst appreciating that demonstrating causality between reusable equipment and transmission of colonising organisms or infection is difficult either is biologically plausible. There are also issues of non-cleaning, lack of clarity about who’s role it actually is to clean reusable equipment, how frequently they need to be cleaned or reprocessed etc. These issues have plagued us for at least 3 decades that I know of and likely longer. I’m wondering what others in Australia and beyond think about single-use pt care items

So my questions are:

1. Has any ACIPC colleague successfully built a business case to convert their facility to single-use pt equipment? If so who was involved in that process?;

2. Which pieces of pt equipment do folks think are most in need of single-use alternative options?;

3. Other than price, storage, supply and environmental/waste issues and lack of detailed science what other factors would need to be addressed to help convince you or your organisation’s decision makers to invest in specific single-use equipment?.

I’d be grateful for any discussion here or as PMs on the email address below. If anyone is interested in my further work around this issue please email me.

Regards
Cath

Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
Cath@infectioncontrolplus.com.au

Adjunct Professor
Griffith University, School of Nursing and Midwifery