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Background: Operating rooms contribute to over 40% of hospital expenses, with a portion attributed to waste from single-use, sterile surgical supplies (SUSSS). This research aimed to determine the amount of cost wastage due to not using SUSSS during laparotomy procedures., Methods: A descriptive-analytical investigation was conducted in two prominent teaching hospitals in Mashhad, Iran 2018. Seventy-seven laparotomy surgeries were scrutinized, documenting both used and unused disposable devices, with their respective costs being assessed. Data analysis was performed using SPSS version 16 software., Results: The study revealed that during surgery in the operating rooms, waste of SUSSS averaged 5.9%. Betadine solution and sterile Gauze types were the top two contributors to resource wastage. Sterile Gauze types incurred the highest cost loss. The study found a significant correlation between cost wastage and surgeon experience (r = 0.296, P < 0.001) as well as surgery duration (r = 0.439, P < 0.001)., Conclusion: Inadequate management of available and commonly used disposable supplies leads to increased hospital expenses. Enhancing the surgical team's knowledge of sterile surgical supplies usage and making thoughtful selections can play a vital role in curbing health costs by minimizing waste of SUSSS in the operating rooms., (© 2024. The Author(s).)

Objectives: To quantify differences in waste and cost of disposable equipment between different tonsillectomy techniques., Methods: Prospective study of waste attributable to disposable waste produced by tonsillectomy surgery. Disposable equipment required for tonsillectomy using cold, monopolar electrocautery (ME), and coblation techniques was measured; and differences in mass, volume, and cost of equipment between the 3 techniques were quantified., Results: Cold technique was found to produce the least waste and have the lowest cost attributable to disposable surgical equipment. Projected single-case savings in mass and volume of waste resulting from using cold technique compared to ME were 1.272 kg and 1.013 L, respectively, and 1.043 kg and 1.723 L compared to coblation. Projected single-case savings in cost of disposable equipment for cold technique compared to ME were US$9.35 and US$185.05 compared to coblation., Discussion: Using cold technique for adult tonsillectomy reduces waste and cost of disposable equipment compared to ME and coblation. Implications for Practice: Surgeons desiring to reduce cost and waste associated with tonsillectomy surgery may consider transitioning to cold technique.

Background: The coronavirus disease-2019 (COVID-19) pandemic presented a major medical management challenge to ophthalmology departments throughout Israel., Objectives: To examine the managerial challenges, actions taken, and insights of directors of ophthalmology departments in Israel during the COVID-19 pandemic., Methods: We conducted a cross sectional survey of directors of ophthalmology departments during the COVID-19 pandemic while the Israeli population was quarantined., Results: All 21 directors answered the survey. The majority of the COVID-19 admissions were located in the center of Israel (53%) and Jerusalem (30%). E-communication took a central role in coping with the pandemic with 80% of the directors satisfied with this form of communication; 75% reported a reduction in clinical and surgery volume of at least 25%, and 40% reported reallocations of manpower. Most of the medical staff used gloves, a face shield, disposable robe, and a mask with no uniformity across departments. Cross satisfaction was noted regarding a hospital's ability to equip the departments. Lack of preparation for post-pandemic era was reported by all directors, but one (95%). Directors sought guidelines and uniformity regarding outpatient referral to the hospital (p = 0.035)., Conclusions: Guidelines via safe digital platforms aid in management decisions and uniformity across departments. Advanced preparation is needed to prevent adverse clinical outcomes and to maintain treatment continuum. Our results can be used to guide and help improve the preparedness of ophthalmology departments during COVID-19 and for future pandemics.

The COVID-19 pandemic has laid bare the inadequacy of the U.S. healthcare system to deliver timely and resilient care. According to the American Hospital Association, the pandemic has created a $202 billion loss across the healthcare industry, forcing health care systems to lay off workers and making hospitals scramble to minimize supply chain costs. However, as the demand for personal protective equipment (PPE) grows, hospitals have sacrificed sustainable solutions for disposable options that, although convenient, will exacerbate supply strains, financial burden, and waste. We advocate for reusable gowns as a means to lower health care costs, address climate change, and improve resilience while preserving the safety of health care workers. Reusable gowns' polyester material provides comparable capacity to reduce microbial cross-transmission and liquid penetration. In addition, previous hospitals have reported a 50% cost reduction in gown expenditures after adopting reusable gowns; given the current 2000% price increase in isolation gowns during COVID-19, reusable gown use will build both healthcare resilience and security from price fluctuations. Finally, with the United States' medical waste stream worsening, reusable isolation gowns show promising reductions in energy and water use, solid waste, and carbon footprint. The gowns are shown to withstand laundering 75-100 times in contrast to the single-use disposable gown. The circumstances of the pandemic forewarn the need to shift our single-use PPE practices to standardized reusable applications. Ultimately, sustainable forms of protective equipment can help us prepare for future crises that challenge the resilience of the healthcare system., (Copyright © 2020 Baker, Bromley-Dulfano, Chan, Gupta, Herman, Jain, Taylor, Lu, Pannu, Patel and Prunicki.)

One-fourth of all operating room (OR) waste is attributed to anesthesia-related material. The goal of this project was to reduce the waste and increase cost savings of opened and unused endotracheal (ET) tubes and disposable laryngoscope handles and blades in 2 separate OR environments. The production of these unused anesthesia supplies was assessed weekly in each of 2 OR environments for 8 weeks before an educational intervention, and for 8 weeks following the intervention. The average weekly waste production was summarized for each study period, compared between periods (preintervention vs postintervention), and analyzed per 100 surgeries using the 2-sample t test. The overall average weekly waste for ET tubes was significantly reduced from 26.7 ± 10.7 to 10.0 ± 6.1 from pre to post intervention (P = < .001), representing a 62.6% reduction. A similar significant reduction in waste was observed for laryngoscope handles (15.9 ± 8.1 vs 7.2 ± 3.1; P = .004; a 54.7% reduction) and laryngoscope blades (21.5 ± 11.0 vs 9.9 ± 4.4; P = .004; a 54.0% reduction). These results highlight the significance and feasibility of an educational intervention in reducing the environmental and economic waste produced by anesthetic practices in the OR., Competing Interests: This project was in part supported by the Department of Surgical Services, Mayo Clinic, and by the Mayo Clinic School of Health Sciences, Rochester, Minnesota. The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright© by the American Association of Nurse Anesthetists.)

Context/Objective: Inadequate bladder management in spinal cord injury (SCI) patients results in significant morbidity and even mortality. Clean intermittent catheterization (CIC) is the recommended option for SCI patients. The objective of the study was to document the bladder management practices of SCI patients in a developing country. Design: Questionnaire based cross sectional survey Setting: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan Participants: All patients with SCI (irrespective of duration, level and etiology) Interventions: Data documentation included demographics, level, severity and time since injury, bladder management techniques used, details of CIC, results of Urodynamic studies (if available), complications resulting from bladder management technique and patient awareness of the yearly follow up. SPSS V 20 was used for analysis. Outcome Measures: Not applicable Results: Thirty four consenting patients were enrolled. All were males. Mean age was 31.24 ± 10.9. Most (17) of the patients were thoracic level paraplegics, while 12 patients had sustained a cervical SCI. Majority (23) had complete injury (ASIA A). Fifteen patients used CIC for bladder management followed by in dwelling Foley catheters in thirteen patients. Those using CIC performed the procedure every four hours and used disposable catheters. The same 'disposable' catheter was used for 5-7 days by half of these patients. Only Six patients independently performed CIC. Three patients on CIC reported urinary tract infection. Conclusions: In the largest spinal rehabilitation unit of a developing country; Pakistan CIC was the preferred method of bladder management followed by indwelling catheter. Re-use of disposable catheters is a common practice due to cost issues. The rate of UTI was significantly lower in patients on CIC.

The Västra Götaland region carried out a project to develop resource-efficient surgeries using standardized hip prosthesis surgery as case. The purpose was to reduce and streamline the use of consumables and thus reduce the climate impact. At the surgery departments of three hospitals, significant variations were found in the supply and use of consumables during operations for total hip replacement (5.0-6.6 kg dry weight/operation). The major part of disposables consisted of surgery textiles, and choosing fossil-free products has the beneficial impact on a carbon footprint. Customized surgical procedure trays significantly reduce the number of packages and result in reduced work load for the staff. However, since there is a long term trend to increase the use of consumables in such sets, there is a need of continuous monitoring of such choices. In summary, a critical review of routines for care and use of materials is a powerful tool for streamlining healthcare and reducing its climate impact.

Background: Rising health care costs have led to increasing focus on cost containment and accountability from health care providers. We sought to explore surgeon awareness of supply costs for open and laparoscopic distal gastrectomy., Methods: Surveys were sent in 2015 to surgeons at 8 academic hospitals in Toronto who performed distal gastrectomy for gastric adenocarcinoma. Respondents were asked to estimate the total cost, type and number of disposable equipment pieces required to perform open and laparoscopic distal gastrectomy. We determined the accuracy of estimates through comparisons with procedural invoices for distal gastrectomy performed between Jan. 1, 2011, and Dec. 31, 2015. All values are in 2015 Canadian dollars., Results: Of the 53 surveys sent out, 12 were completed (response rate 23%). Surgeon estimates of total supply costs ranged from $500 to $3000 and from $1500 to $5000 for open and laparoscopic cases, respectively. Estimated supply costs for requested equipment ranged from $464 to $2055 for open cases and from $1870 to $2960 for laparoscopic cases. Invoices for actual equipment yielded a mean of $821 (standard deviation $543) (range $89-$2613) for open cases and $2678 (standard deviation $958) (range $835-$4102) for laparoscopic cases. Estimates of total cost were within 25% of the median invoice total in 1 response (9%) for open cases and 3 (27%) of those for laparoscopic cases., Conclusion: Respondents failed to accurately estimate equipment costs. The variation in true total costs and estimates of supply costs represents an opportunity for intraoperative cost minimization, efficient equipment selection and value-based purchasing arrangements., Competing Interests: J. Hallet has received speaking honoraria and unrestricted grants from Novartis Oncology and Ipsen Biopharmaceuticals Canada. No other competing interests declared., (© 2018 Joule Inc. or its licensors)

Introduction: Nosocomial pneumonia accounts for the vast majority of healthcare-associated infections (HAI). Although numerous medical devices have been discussed as potential vehicles for microorganisms, very little is known about the role played by oxygen humidifiers as potential sources of nosocomial pathogens. The purpose of this research was to evaluate the safety of the reuse of humidifiers by analysing the rate of microbial contamination in reusable and disposable oxygen humidifiers used during therapy, and then discuss their potential role in the transmission of respiratory pathogens., Methods: Water samples from reusable and disposable oxygen humidifiers were collected from different wards of the University Hospital of Messina, Italy, where nosocomial pneumonia has a higher incidence rate due to the "critical" clinical conditions of inpatients. In particular, we monitored the Internal Medicine and Pulmonology wards for the medical area; the General Surgery and Thoracic and Cardiovascular Surgery wards for the surgical area and the Intensive Care Unit and Neonatal Intensive Care Unit for the emergency area. The samples were always collected after a period of 5 days from initial use for both types of humidifiers. Samples were processed using standard bacteriological techniques and microbial colonies were identified using manual and automated methods., Results: High rates of microbial contamination were observed in samples from reusable oxygen humidifiers employed in medical (83%), surgical (77%) and emergency (50%) areas. The most relevant pathogens were Pseudomonas aeruginosa, amongst the Gram-negative bacteria, and Staphylococcus aureus, amongst the Gram-positive bacteria. Other pathogens were detected in lower percentage. The disposable oxygen humidifier samples showed no contamination., Conclusions: This research presents evidence of the high rate and type of microbial contamination of reusable humidifiers employed for oxygen therapy. These devices may thus be involved in the transmission of potential pathogens. It could be important, for the prevention of nosocomial pneumonia, to replace them with singleuse humidifiers for which the absence of microbial contamination has been confirmed., Competing Interests: the authors declare that there are no conflicts of interest.

OBJECTIVE To evaluate the knowledge and biosafety practices adopted by professionals of the beauty segment. METHODS Descriptive study, of survey type. 238 professionals of the beauty segment were interviewed between August 2014 and 2015. The variables were expressed by means of absolute and relative frequencies, as well as average and standard deviation. RESULTS 62.6% of the interviwed professionals reported having had contact with blood from customers when they were not wearing gloves; 74.4% said they washed their hands before and after each service, and only 16.8% of the respondents reported reusing nonsterilizable materials. None of them was able to inform the correct number of sets of tools needed , and 32.8% of the respondents did not use Personal Protective Equipment during their work activities. CONCLUSIONS The most frequently reported diseases associated with the risk of infection and transmission in the work activities were viral hepatitis, HIV and fungi. Regarding the biosafety procedures adopted, autoclave is the least used method for sterilizing devices.

Insulin pens are more accurate and easier to teach than other methods of insulin delivery. They also do not suffer from the risk of mismatch of insulin concentration and type of insulin syringe. The ISO standard used to test insulin pens, however, needs to be updated to reflect their clinical use., (© 2015 Diabetes Technology Society.)

Background: Voluntary medical male circumcision (VMMC) is a priority HIV preventive intervention. To facilitate VMMC scale-up, the World Health Organization is seeking circumcision techniques that are faster, easier, and safer than open surgical methods., Objective: To compare open surgical circumcision with suturing v. the Unicirc disposable instrument plus tissue adhesive., Methods: We conducted a non-blinded randomised controlled trial at an outpatient primary healthcare clinic in Cape Town, South Africa, with 2:1 allocation ratio of 150 male volunteers who were at least 18 years of age. Our primary outcome was intraoperative time and secondary outcomes were ease of performance, post-operative pain, adverse events, time to healing, patient satisfaction and cosmetic result., Results: The intraoperative time was less with the Unicirc/adhesive technique (median 13 v. 22.6 min, respectively; p<0.001). The intraoperative suturing rate was 17% using the Unicirc device. Other adverse events and wound healing outcomes were similar in both groups, but the cosmetic result was superior in the Unicirc group. Doctors found the Unicirc procedure easier to perform and preferred it to the open surgical technique., Conclusions: This study has important implications for the scale-up of VMMC services. Excising the foreskin with the Unicirc instrument and sealing the wound with cyanoacrylate tissue adhesive in adults is quicker, easier to learn, and is potentially safer than open surgical VMMC. Further studies should be conducted with the optimised device. This new instrument has the potential to facilitate more rapid scale-up and save costs.

As the use of negative pressure wound therapy (NPWT) over skin grafts has increased, traditional methods of NPWT system reimbursement and application are increasingly being challenged. A simplified method of accessing and operating NPWT in the outpatient setting is needed, particularly in cases where immediate outpatient use of NPWT is optimal. We evaluated use of a new ultra-lightweight, off-the-shelf, disposable, single-patient-use NPWT system (SP-NPWT; V.A.C.Via™ Therapy, KCI USA, Inc., San Antonio, TX) over dermal regeneration template (DRT) and/or skin grafts. SP-NPWT was initiated over a DRT and/or skin graft in 33 patients with 41 graft procedures. Endpoints were recorded and compared to a historical control group of 25 patients with 28 grafts bolstered with traditional rental NPWT (V.A.C.® Therapy, KCI USA, Inc.). Average length of inpatient hospital stay was 0·0 days for the SP-NPWT group and 6·0 days for the control group (P < 0·0001). The average duration of SP-NPWT post-DRT or skin graft was 5·6 days for the SP-NPWT group and 7·0 days for the control (P < 0·0001). Preliminary data suggest that, compared to traditional NPWT, off-the-shelf SP-NPWT may provide a quicker, seamless transition to home, resulting in decreased hospital stay and potential cost savings., (© 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.)

Spectacles are routinely prescribed by the ophthalmologist and dispensed by the opticians. We investigated how frequently the spectacles are not dispensed as prescribed and whether the frequency of inaccurate spectacles would decrease if the patients, at the time of collecting spectacles, ask the optician to verify that the spectacles have been dispensed accurately. We found inaccurate spectacles in about one-third of our patients and incorrect spherocylinders more frequently with an error in the spherical element and cylinder axis. These inaccuracies decreased significantly when patients while collecting spectacles, asked the optician to verify the accuracy of the spectacles dispensed. It is suggested that while prescribing spectacles, the patients should be made aware of the possibility of dispensing errors. To decrease the frequency of incorrect spectacles, the patients while collecting spectacles, should ask the optician to check whether the spectacles have been dispensed accurately.

Background: Impaired dexterity has been reported to be prevalent in diabetes patients independent from the existence of diabetic neuropathy. This study was performed to investigate the impact of dexterity impairment on patient preference for two insulin pen injection devices (InnoLet and FlexTouch)., Methods: Ninety patients [54 male/36 female; age (mean ± standard deviation), 62 ± 8 years; disease duration, 18 ± 11 years; hemoglobin A1c, 7.2 ± 1.0%] were included in this investigation and were stratified into four different groups based on the results of a dexterity test (Jebsen-Taylor Hand Function Test) and assessment of visual impairment: 15 type 1 (group A) and 30 type 2 (group B) patients with impaired dexterity, 30 type 1/type 2 patients with visual impairment (group C), and 15 type 1/type 2 patients without any impairment (group D). The patients performed a cognitive function test (number connection test), were introduced to the devices in random order, and were asked to perform some mock injections before completing a six-item standardized preference questionnaire., Results: There was a strong preference for FlexTouch in all groups. All unimpaired patients (100%, group D) preferred FlexTouch, as did the vast majority in all other groups. Only 11% of the patients with impaired cognitive function preferred InnoLet, as did a few patients with more severely impaired dexterity or with visual impairment (group A, 13%; group B, 3%; group C, 14%)., Conclusions: Patient dexterity skills may have an influence on device preference, especially if the impairment is more pronounced., (© 2012 Diabetes Technology Society.)

Background: For most items used in operating rooms, it is unclear whether reusable items are environmentally and financially advantageous in comparison with single-use variants. We examined the life cycles of reusable and single-use central venous catheter kits used to aid the insertion of single-use, central venous catheters in operating rooms. We did not examine the actual disposable catheter sets themselves. We assessed the entire financial and environmental costs for the kits, including the influence of the energy source used for sterilization., Methods: For the reusable central venous catheter kit, we performed a "time-in-motion" study to determine the labor costs and measured the energy and water consumption for cleaning and sterilization at Western Health, Melbourne, Australia. For the majority of the inputs for the single-use kit, we relied upon industry and inventory-sourced databases. We modeled the life cycles of the reusable and single-use central venous catheter kits with Monte Carlo analysis., Results: Inclusive of labor, the reusable central venous catheter insertion kits cost $6.35 Australian ($A) (95% confidence interval [CI], $A5.89 to $A6.86), and the single-use kits cost $A8.65. For the reusable kit, CO(2) emissions were 1211 g (95% CI, 1099 to 1323 g) and for the single-use kit 407 g (95% CI, 379 to 442 g). Water use was 27.7 L (95% CI, 27.0 to 28.6 l) for the reusable kit and 2.5 L (95% CI, 2.1 to 2.9 l) for the single-use kit. For the reusable kit, sterilization had the greatest environmental cost, and for the single-use kit, the manufacture of plastic and metal components had the largest environmental costs. Different sources of electricity to make the reusable kits patient-ready again affected the CO(2) emissions: electricity from hospital gas cogeneration resulted in 436 g CO(2) (95% CI, 410 to 473 g CO(2)), from the United States electricity grid 764 g CO(2) (95% CI, 509 to 1174 g CO(2)), and from the European electricity grid 572 g (95% CI, 470 to 713 g CO(2))., Conclusions: Inclusive of labor, the reusable central venous catheter insertion kits were less expensive than were the single-use kits. For our hospital, which uses brown coal-sourced electricity, the environmental costs of the reusable kit were considerably greater than those of the single-use kit. Efforts to reduce the environmental footprint of reusable items should be directed towards decreasing the water and energy consumed in cleaning and sterilization. The source of hospital electricity significantly alters the relative environmental effects of reusable items.

During experimental Eimeria infections in chickens, facilities are often contaminated by fecal oocysts known to be highly resistant to both chemical and enzymatic treatments. Thus, studies using experimental Eimeria infections have been limited due to the difficulty of complete elimination of residual oocysts from both cages and facilities. To overcome this limitation, simple, inexpensive, and disposable cages were constructed from cardboard boxes and tested during experimental Eimeria maxima infections. The cages were used in animal rooms with only a 1.7% evidence of coccidia contamination between adjacent cages. No significant differences in fecal oocyst output and body weight gain were noted between animals housed in disposable cages and animals housed in wire control cages. This cage design is a useful means for preventing oocyst contamination during experimental conditions, suggesting that this disposable cage design could be used for other avian infectious disease studies.

Background: Limited data are available on the predictors of insulin delivery device choice. This study assessed the patient- and health-care-system-related factors that predict the initiation of one rapid-acting insulin analog (RAIA) delivery system over another., Methods: A retrospective analysis using a claims database (January 1, 2007, through March 31, 2009) was conducted. Patients were required to be diagnosed with type 2 diabetes mellitus, and have >or=12 months of continuous eligibility prior to their first prescription of a RAIA on or after January 1, 2008. The three cohorts in the study were vial/syringe (n = 6820), prefilled pen (n = 5840), and reusable pen (n = 2052). Multiple factors were examined using stepwise logistic regression., Results: Factors that increased the likelihood of initiating RAIA using prefilled pen versus vial/syringe included endocrinologist visit [odds ratio (OR) = 3.13, 95% confidence interval (CI) = 2.56, 3.82], prior basal insulin use with pen (OR = 4.85, 95% CI = 4.21, 5.59), and use of >or=1 oral antihyperglycemic agents (OR = 1.32, 95% CI = 1.20, 1.45). Factors that decreased the likelihood included inpatient admission (OR = 0.76, 95% CI = 0.70, 0.83), nursing home visit (OR = 0.22, 95% CI = 0.18, 0.27), and obesity (OR = 0.67, 95% CI = 0.53, 0.83). There were fewer differences between prefilled and reusable pen initiators. Factors that increased the likelihood of initiating with prefilled versus reusable pen included endocrinologist visit (OR = 1.87, CI = 1.50, 2.34) and inpatient admission (OR = 1.46, 95% CI = 1.30, 1.64)., Conclusion: Significant differences in predictors were observed between prefilled pen and vial/syringe initiators. The differences were fewer between prefilled and reusable pen initiators. These differences should be taken into consideration when evaluating outcomes associated with specific insulin delivery systems., ((c) 2010 Diabetes Technology Society.)

A national survey investigated the current practices of reprocessing and reusing single-use medical devices in Canadian acute-care hospitals. Our response rate was 72% (413 responses), and 28% of hospitals reprocess single-use devices. The results showed that Canadian hospital practices have not changed much in the past decade.

Background: The emergence of variant Creutzfeldt-Jakob disease (vCJD) prompted guidelines from the Department of Health that stress the use of disposable and protective equipment. This survey explores current methods of airway management for tonsillectomy in the UK and ascertains anaesthetists' current knowledge and opinions of the guidelines and of vCJD., Methods: Three hundred and five questionnaires were sent to all Royal College tutors across the UK to explore the current practice and adherence to the guidelines., Results: The tracheal tube was the most frequently used airway across all age groups: 87% for <3 yr old, 79% for 3-16 yr old, and 73% for adults. Of the respondents who intubated, 57% protected the laryngoscope blade with a disposable sheath or used a disposable blade, while others used a reusable laryngoscope blade without protection. Fourteen per cent protected the laryngoscope handle, as recommended. When a reusable classic or flexible laryngeal mask airway was used, 45% reused it after routine sterilization. Thirty-eight per cent of respondents were unaware that any recommendations existed, 55% disagreed with them, and 84% were not fully compliant with them. Compliance rates did not differ between the anaesthetists who agreed or disagreed with the recommendations. Overall full compliance was achieved by only 16% of respondents. The most common reason for non-compliance was the lack of protection of the laryngoscope handle., Conclusions: The survey demonstrates widespread non-compliance with and lack of knowledge of, national guidelines.

Purpose: To explore whether there was a significant relationship between difficulty paying for ostomy supplies and overall quality of life among a sample of ostomates receiving care from the Veterans Health Administration (VHA)., Methods: The data were collected as part of the Veterans Affairs (VA) Ostomy Health-Related Quality of Life Study, in which 511 respondents (239 cases, 272 controls) completed a survey instrument that included the modified City of Hope Quality of Life (mCOH-QOL) Ostomy questionnaire, SF-36V, and sociodemographic items. Responses from the 239 cases (ie, patients with intestinal stomas) were used in this analysis. The modified City of Hope Quality of Life Ostomy questionnaire item, "How good is your overall quality of life?," was the dependent variable for this analysis. The primary independent variable was the response (yes/no) to the item, "If you pay for any of the (ostomy) costs, is it difficult for you?" A hierarchical regression model was used to examine whether difficulty paying was significantly related to overall quality of life after adjusting for age, income, race/ethnicity, and physical health., Results: After accounting for the proportion of variance explained by age, income, race/ethnicity, and physical health, the additional proportion of variance explained by difficulty paying was statistically significant. Individuals reporting difficulty paying had a roughly 1 point lower (ie, beta-coefficient = -1.052; SE = 0.481) overall quality of life score on the 11-point scale., Conclusions: We found a significant association between difficulty paying for ostomy supplies and overall quality of life. Although the cross-sectional study design does not allow causal inference, the results suggest a relationship that merits further examination.

Objective: To determine amount of syringes used in the hospital and extent of contact with blood and body fluids of these syringes., Material and Methods: Syringe use was surveyed at a tertiary care center for one week; syringes were classified into the following four categories according to use: a) contained blood; b) contained other body fluids (urine, gastric secretion, cerebrospinal fluid, wound drainage); c) used exclusively for drug dilution and application in plastic intravenous (i.v.) tubes, and d) for intramuscular (i.m.), subcutaneous (s.c.), or intradermic (ID) injections., Results: A total of 7,157 plastic disposable syringes was used; 1,227 (17%) contained blood during use, 346 (4.8%), other body fluids, 5,257 (73%) were used exclusively for drug dilution and application in plastic i.v. lines, and 327 (4.5%) were utilized for i.m., s.c., or ID injections. An estimated 369 140 syringes used annually, or eight syringes per patient per in-hospital day. All syringes were disposed of as regulated medical waste, in observance of the law., Conclusions: There is an urgent need to review recommendations for medical waste management by both international agencies and local governments, based on scientific data and a cost-benefit analysis, to prevent resource waste and further environmental damage. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

This descriptive study aims at learning about the behavior of 113 people with diabetes mellitus assisted at a large hospital in relation to the utilization and re-utilization of disposable syringes for the administration of insulin at home. Semi-structured interviews were used for data collection. The obtained results showed that 98.2% used a disposable syringe for insulin application and only 5.3% actually disposed of it. Among these, 94.6% re-used the disposable syringe after application by means of various procedures. We believe that such practice is one of the facets in diabetes education and, in view of it, we point out the need for a scientifically-based review of DIMED's recommendation established by Decree no. 4/86.

Objectives: We sought to evaluate the performance of angioplasty catheters, restored under a strict manufacturing process, in patients with coronary artery disease., Background: Most countries outside the United States routinely reuse disposable medical equipment, resulting in significant cost savings. Because of quality and legal concerns, reuse in the United States has been limited. We investigated the reuse of percutaneous transluminal coronary angioplasty (PTCA) balloon catheters, restored by a process strictly controlled for bioburden and sterility, in patients undergoing PTCA., Methods: Used PTCA balloon catheters were shipped to a central facility and were decontaminated, cleaned and tested for endotoxin using the limulus amebocyte lystate (LAL) gel clot method. Physical testing and quality assurance were performed. The products were packaged and sterilized with ethylene oxide. Catheter performance was assessed in a pilot study powered to detect a 5% difference in the angiographic failure rates of new and reused balloons (beta 0.8)., Results: The study enrolled 107 patients. The indication for PTCA was stable angina pectoris in 69 patients, unstable angina in 22 and acute myocardial infarction in 16. Of the 107 patients enrolled, 106 had a successful laboratory outcome, and 1 required coronary artery bypass graft surgery after failed rescue stenting. There were 122 lesions attempted (American College of Cardiology/American Heart Association classification A, n = 32; B1, n = 43; > or = B2, n = 35; C, n = 12). Of the 110 lesions initially approached with restored PTCA catheters, 108 were crossed and dilated. Sixty-four required no further procedures. Stenting was performed in 37 patients (29 planned, 8 rescue). Thus, the angiographic failure rate was 7% (10 of 108, 95% confidence interval 2% to 12%), comparable to the 10% rate seen with new balloons in other studies., Conclusions: Restoration of disposable coronary angioplasty catheters using a highly controlled process appears to be safe and effective, with success rates similar to those of new products and no detectable sacrifice in performance. Cost analysis suggests that implementation of reuse technology for expensive disposable equipment may offer cost savings for U.S. hospitals, without sacrifice of quality.

Objective: To evaluate the cost benefits of reusing disposable laparoscopic instruments., Design: A cost-analysis study based on a review of laparoscopic and thoracoscopic procedures performed between August 1990 and January 1994, including analysis of disposable instrument use, purchase records, and reprocessing costs for each instrument., Setting: The general surgery department of a 461-bed teaching hospital where disposable laparoscopic instruments are routinely reused according to internally validated reprocessing protocols., Methods: Laparoscopic and thoracoscopic interventions performed between August 1990 and January 1994 for which the number and types of disposable laparoscopic instruments were standardized., Main Outcome Measures: Reprocessing cost per instrument, the savings realized by reusing disposable laparoscopic instruments and the cost-efficient number of reuses per instrument., Results: The cost of reprocessing instruments varied from $2.64 (Can) to $4.66 for each disposable laparoscopic instrument. Purchases of 10 commonly reused disposable laparoscopic instruments totalled $183,279, and the total reprocessing cost was estimated at $35,665 for the study period. Not reusing disposable instruments would have cost $527,575 in instrument purchases for the same period. Disposable laparoscopic instruments were reused 1.7 to 68 times each., Conclusions: Under carefully monitored conditions and strict guidelines, reuse of disposable laparoscopic and thoracoscopic instruments can be cost-effective.

Reusing pulse oximeter sensors is more economical for hospitals, but making the switch from disposables won't be easy. Personnel are used to the convenience of one-use sensors, and there's been some concern about the possibility that blood-borne diseases could be transmitted. But economics may win out--one industry executive says hospitals could save $100 million annually by going with reusables.

Nebuliser drug delivery units were reused in 15% of paediatric wards participating in a national survey, while routine servicing and written information was provided by only half the wards issuing home nebulisers. Written information should be developed as a national resource, and further research on optimal cleaning practices is required.

Disposable linens have blanketed the hospital market since the 1970s, but reusable products are attracting renewed interest. Sparking the reassessment are elevated costs of medical-waste disposal, innovations in recycled linens and blossoming environmental concerns.

Nosocomial respiratory tract infections have occasionally been associated with contaminated respiratory therapy devices and techniques. In the past two years, our hospital purchased disposable saline squeeze vials for use during suctioning of intubated patients. These vials have a cap which must be flipped or twisted-off by the user before the contents can be instilled into the patient's respiratory tract. We observed use of this item in our intensive care units (ICU) and studied the potential for contamination. ICU nurses use ungloved hand(s) to flip or twist-off squeeze vial cups resulting in skin contact with the vial opening. Cultures of nurses' hands and squeeze vial contents were obtained in the ICU where 24 nurses opened 92 vials in the manner previously described. Twenty-three percent of vial contents were contaminated and cultures revealed S. epidermidis, S. aureus, Streptococcus viridans and enterococcus. On six occasions, organisms recovered from vial contents were believed to be identical to organisms isolated from the hands of the nurse who opened the vial. When nurses used care in removing the saline vial cap, cultures of vial contents were sterile.

Rising health care costs have prompted hospitals to turn to reprocessing and reuse of disposable devices as a cost-saving measure. The safety, efficacy, and cost benefit of such a practice are largely unknown. Classification schemata are presented as a means of categorizing the reasons for reprocessing and the types of adverse effects that may result from reprocessing and reuse. The very limited literature on reuse of disposable devices is reviewed. Examples of the categories of reprocessing and adverse effects are provided from a review of the experience with reprocessing and reuse at a university medical center. With the rising pressure for containment of health care costs, it is likely that this practice will expand further. The practice of reprocessing and reuse should be subjected to scientific study.

In a survey undertaken in the west of Scotland 801 adult diabetics taking insulin were questioned about their use of disposable or non-disposable needles and syringes, the life of such equipment, infected injection sites, and future preferences. Six hundred and eight preferred to use disposable equipment even if it meant reusing it; of the 413 who already bought disposable needles, 211 reused them, and of the 234 who bought disposable syringes, 153 reused them. Comparison of total annual costs showed that disposable equipment used only once was more expensive than non-disposable equipment. Reuse of disposable equipment for a few days, however, considerably reduced annual costs when compared with non-disposable equipment. Fewer infected injection sites were recorded in patients reusing disposable equipment without sterilisation than in patients sterilising non-disposable equipment according to government recommendations.