Tuesday, March 25, 2014

Green Solutions for the Operating Room: Remanufacturing of Single Use Devices

In 2013, the Association of Women Surgeons sponsored its second Green Solutions for the Operating Room Contest in a partnership with Practice Greenhealth.  We received many innovative and creative approaches to reducing the environmental impact of the operating room.  Today we are featuring a submission from Titi Adegboyega, a 4th year medical student at Gundersen Health System in La Crosse, WI.  Congratulations, Titi!


Green Solutions for the Operating Room: 
Remanufacturing of Single Use Devices
Gundersen Health System, La Crosse, WI

By Titi Adegboyega

My interest in medicine has been deeply rooted in my passion for global health. As I go through my training, I always ask myself what obstacles I would face if I plan to execute the same treatment plan I just provided a patient in Wisconsin to a similar patient in a rural town in Nigeria. Specifically, I consider how performing surgery here in the United States can be very different from doing surgery in a developing country. The limited resources in these areas sometimes preclude the use of laparoscopy and expensive devices like staplers and vessel sealing devices. In addition to the cost of securing these instruments, the one-time use makes them a deterrent to in light of limited funds. Innovations to recycle these devices are one way to make these expensive devices cost effective.

Single Use devices (SUD) are commonly used in the operating room. With growing number of minimally invasive procedures, the use of SUD such as laparoscopic trocars has also grown. Likewise, there has been a surge in use of the LigaSure and Harmonic, both SUDs utilized in many surgical procedures for vessel sealing and dissection. For over ten years, Gundersen Health System (GHS) has been participating in remanufacturing of single use devices. The list of the most common devices remanufactured a listed in table 1. In other to reduce waste, GHS recycles 95% of SUD although only about 2% is actually remanufactured and packaged for reuse based on the Food and Drug Administration guidelines. The recycled products are diverted away from the regulated medical waste stream which results in ‘waste savings’.
                                                                                                                    
The process of recycling involves placing items for recycling in clearly labeled teal Stryker containers in each operating room. These items are sent to one of the two processing plants in the US (Arizona and Florida). Items are then sorted for recycling versus remanufacturing. There is no additional cost of recycling to GHS and no additional personnel required as SUD are placed in the recycle bins immediately after surgery by the OR staff.

The safety of utilization of SUD is a potential concern for both patients and healthcare organizations. The department of infection control and infectious diseases is engaged in the remanufacturing process and each remanufactured device is inspected multiple times in the cleaning, sterilization and repackaging process to insure quality and safety.

The average cost of medical waste disposal is $0.50 per pound. In 2013 alone, GHS has recycled 7,843 pounds, resulting in a waste savings of $3,924. GHS has also saved $161, 360 this year alone from reusing of SUD (figure 1).

The cost savings attained from recycling SUD makes it more suitable for low resource environments and is one of many innovative ways to bridge the difference in surgical care globally.  I hope to incorporate this in my career in global surgery to maximize the limited resources available to care for patients.




Table 1: Remanufactured OR products
Arthroscopic Shavers / Burs
Burrs / Bits / Blades
Cardiac Stabilization
Compression Device - Pairs
EP Catheters & Cables
Endoscopic Trocars
External Fixation
Ligasures
Opened & Unused / Expired
Suture Passers
Tourniquet Cuffs
Ultrasonic Scalpels


Figure 1: 2013 Monthly savings on utilization of remanufactured Single Use Devices


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Titi Adegbboyega is a fourth year surgery resident at Gundersen Health System in La Crosse, WI. She completed medical school at the University of Minnesota and is interested in global surgery.


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