A reusable solution to health costs?

The use of throwaway supplies in the healthcare industry has often been examined--from environmental, cost, safety and comfort angles. In a recent New York Times article (11 / 30 / 93)--bearing the title above without the question mark--the controversy over reusable vs. disposable hospital supplies was addressed primarily from a cost perspective. The newspaper reported that, under pressure from the government and medical insurance companies to reduce hospital spending, more and more institutions are reevaluating the economics of throwaway supplies. Estimated to be 80% of the $1.2 billion spent on operating room equipment, throwaway supplies include instrument trays, some surgical instruments, CSR wrap, gowns, caps, masks and booties.

While the feasibility of recycling plastic instrument trays and the instruments themselves has been studied and even initiated at several institutions, the debate over reusing protective operating room apparel has led to very differing opinions. On the money side, cost consciousness has prompted a few institutions to switch to a new type of reusable protective operating gown, according to the New York Times. In addition, the article asserts that some vendors of disposables have offered to lower their prices to keep hospital customers or have even begun to carry reusables in their inventories.

Operating room staff safety was also reported, to have a role in effecting the change from disposable to reusable gowns, at least at the R Adams Crowley Shock Trauma Center, Baltimore, MD, where an orthopedic surgeon had a patient's blood soak through a supposedly impenetrable disposable gown to her skin.

As detailed in the article, this increasing interest in reusables at certain locations has given rise to a strengthened industry of laundering and sterilizing reusable protective materials. In addition, in citing the greater use of reusables in Europe and Canada, the article presents these higher rates of recyclability as goals to which the U.S. should aspire.

Yes, But What About...

But the article leaves out some key points.

While it states that certain healthcare operations have switched to reusables for cost, safety and environmental reasons, the article fails to detail the poor record some reusable suppliers have had recently. For example, Repak Surgical Enterprises, a reusable gown supplier, was highlighted in this publication for Food and Drug Administration (FDA) probes that found it not in compliance with appropriate sterilization procedures at two different locations.

A March 1992 Capital Comments column in NONWOVENS INDUSTRY first brought that particular problem to light, describing the FDA citations for quality control failures, strikethrough incidents and sterilization problems at its Mason, OH facility. A follow up inspection at the company's Denver, CO site revealed additional Good Manufacturing Practice (GMP) violations, detailed in the December 1993 Capital Comments column. These FDA investigations were spurred by complaints from hospitals that used Repak surgical packs and gowns, but no mention of unsatisfied reusable customers was made in the New York Times report.

The article does mention that the FDA has come forward with proposals for tighter controls for new reusable devices. Under the proposed rules, manufacturers would have to prove that the devices were still safe and effective after each processing, indicating that to date, such services may have had difficulty supplying sterile, completely protective surigcal apparel time after time.

In addition, the considerable environmental effects of laundering and sterilizing apparel are not touched upon. And, while Canada and Europe are pointed to as evidence of the recyclability possibilities, no mention is made of the fact that these two regions are in fact moving towards greater use of disposables for operating room apparel as health and safety concerns become more prominent.

In the U.S. the driving force behind the push for safer hospital gowns and materials comes from the Occupational Safety and Health Administration (OSHA), not discussed by the New York Times article. In March 1992, OSHA finalized its rule on worker protection from bloodborne pathogens, mandating that all employers supply employees who are at risk of exposure to blood or other potentially infectious body fluids with personal protective equipment.

While the OSHA rule does not specify the use of disposables over reusables, it does outline extensive guidelines for the handling of soiled products that require laundering and, according to medical product suppliers, it has contributed greatly to the increased levels of impermeable, disposable gowns that are now used in healthcare institutions and dentist's offices around the U.S.

The New York Times article also lumped together in one category all supplies that are possibly recyclable, when the arguments for and against reusability vary considerably with plastic instrument trays, surgical instruments and protective apparel. The safety concerns about medical protective apparel--a deadly serious issue with the prevalence of AIDS, HIV, hepatitis and tuberculosis in today's society--should be the most important issue and vital distinctions must be made in the debate over types of hospital supplies.