It may not be intuitive, but safely reusing medical equipment that has been previously used by doctors or patients can help hospitals save on health care costs, prevent supply shortages and have beneficial knock-on effects for the whole population, say some doctors.
It could also potentially make a dent in the mountains of hospital waste generated each year. In Canada alone, non-hazardous hospital waste could amount to nearly 300 tonnes a day.
Dr. Andrea MacNeill, a surgical oncologist at Vancouver General Hospital is one of several doctors across Canada trying to make the shift from the single-use and disposable equipment hospitals rely on to more reusable masks, gowns and surgical supplies.
They’re also finding ways to recycle single-use items, such as oxygen masks and tubing and IV bags.
MacNeill, a clinical associate professor, is launching the Planetary Health Care Lab at the University of British Columbia in Vancouver that will examine the environmental impacts of health care. She acknowledges that patients often don’t like the idea of using something that has already been used on another patient.
“There is an almost visceral reaction to the idea of reuse,” she said. “I think we’ve been successfully marketed the notion that single-use consumables are safer from an infection prevention perspective, and there’s very little, if any, data to back that up.”
Conversely, she said, there’s is a lot of data showing that reuse is safe when done properly, similar to using the same restaurant utensils as thousands of other patrons.
“There’s no difference between that and using medical devices that have undergone safe-reuse protocols,” MacNeill said.
And there are potential health and environmental benefits to doing so, she suggests.
Preventing equipment shortages
For one thing, reusable equipment could potentially prevent some of the supply problems seen when the COVID-19 pandemic first hit in early 2020.
At that time, some hospitals, long-term care homes and other front-line facilities faced dangerous shortages of personal protective equipment. Some reportedly even had to stop doing front-line work as a result.
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“Part of the reason for that is that we have developed increasing reliance on single-use items, so disposable N95 [respirators], disposable gowns,” MacNeill said.
That was less of a problem at Vancouver General Hospital, where she works, which was well stocked with reusable gowns and respirators.
“Because it’s a lot easier to scale up your reuse cycles, so your laundering of your gowns or your replacement of the filters of your reusable respirators, than it is to actually manufacture more of something,” MacNeill said.
She said supply-chain disruptions such as the ones seen during the pandemic can be expected to become more frequent with future pandemics and climate change-related catastrophes, and the health-care system needs to find ways to address such vulnerabilities.
“One of those is focusing more on reusable supplies rather than single-use consumables.”
Since the start of the pandemic, more research has gone into ways to clean and reuse PPE, such as N95 masks, and some provincial governments have invested in reusable gear. For example, the Manitoba government ordered a million reusable N95 masks that can we worn up to 30 times.
The shortages have also prompted some hospitals to stockpile used masks in case they run out of new ones and need to clean and reuse them.
Reuse can save money
Reusing supplies rather than throwing them away can also cut costs, and some of those savings can be reinvested in patient care.
Since December 2018, St. Joseph’s Health Centre in Toronto has been reusing disposable items such as fingertip oxygen sensors and single-use surgical tools such as harmonic scalpels and trocars for laparoscopic operations that are normally used once before being thrown away. Now, instead of being trashed, they’re cleaned, sterilized, tested and repackaged by a company called Stryker Sustainability Solutions.
The company says each device is individually tested after processing, must meet a U.S. Food and Drug Administration requirement to be “substantially equivalent” to a brand new device and carries a warranty and liability policy similar to those from the original manufacturer. In Canada, each reprocessed device must get a medical device licence before it can be reused.
In 2020, Toronto St. Joseph’s Health Centre estimates it was able to reprocess about 900 devices and purchase 600 reprocessed devices at a discount, saving about $20,000, including $4,000 in waste-hauling costs, said Dr. Ali Abbass, an anesthesiologist and chief of environmental stewardship and sustainability at St. Joseph’s.
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Normally many of the metal items need to go in a sharps container, which is expensive to haul away.
“If you put it in the Stryker collection container, it’s free,” said Abbass, who reached out to the company after hearing about its programs at U.S. hospitals. Abbass said the program is relatively new in Canada after being approved by federal regulators.
The system also reduces environmental costs, as Stryker can reprocess each device five to seven times — reducing the number of new ones that need to be made, Abbass said.
“To me, every hospital in the country should implement it.”
When reuse isn’t possible, recycling may be
Of course, not all materials are durable enough to be cleaned and reused.
That has been the case for disposable medical masks along with IV bags, oxygen masks and oxygen tubing.
For those, recycling may be an option — but one that hasn’t been widely used.
Abbass says that’s likely in part due to the “ick factor,” where hospital waste is perceived to be infectious.
It’s also often hard to find a market even for household plastics that have been recycled let alone recycled medical plastics.
“There’s lots of factors, I think that are in flux,” Abbass said. “And one has to keep following up, I find, to see whether something that isn’t recyclable may now be or vice versa.
Around 2012, Abbass heard of a program in Australia that recycled items made of PVC, such as IV bags, oxygen masks and oxygen tubing. He got in touch to ask how it worked, then found a recycler in Ontario, Norwich Plastics, willing to give it a try.
A pilot program for recycling those items from patients who aren’t infectious started at St. Joseph’s in 2016.
It’s already generated several thousand pounds of recycled PVC that’s being used to make items such as automotive parts, garden hoses and highway sound barriers.
Abbass said his hospital alone uses…