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Secrets to Saving with Reprocessed SUDs
Why aren't more surgical facilities using third-party reprocessors?
Dan O'Connor
Publish Date: October 10, 2007   |  Tags:   Environmental Stewardship

Before you throw away those shaver blades, you might want to think about reusing them - again and again and again and again and again, spending about half as much for each use as you'd spend buying new blades each time. You can if you ship them to a reprocessor instead of tossing them in the trash.

Reader Survey: Do You Send SUDs to a Third-party Reprocessor?

About one-third of the facility managers and surgeons we surveyed use a third-party reprocessor, and another 7.8 percent say they might do so in the future.

Yes

30.7%

No, and we're not planning on it

61.5%

No, but we're considering it

7.8%

We asked those that send SUDs to a third-party reprocessor which devices they send.

orthopedic bits, burrs and blades

72.0%

compression sleeves

64.7%

trocars

48.5%

laparoscopic instruments (graspers, forceps, cutting forceps)

36.8%

harmonic scalpels

26.5%

RF arthroscopic electrodes

23.5%

phaco tips

17.7%

SOURCE: Outpatient Surgery Magazine Reader Survey, June 2007, n=210

Surgeons at Academy Orthopedics in Cumming, Ga., have been using reprocessed shaver blades for more than two years now. Administrator Karen Bennett, RN, ONC, gives reprocessing high grades in all areas. Not once have her surgeons complained about metal shavings in the joint or about blades that dull or fail quickly. Not once has a patient come down with a surgical site infection. And not once has her supply budget not benefited. Plus, she says, the process is pretty simple.

"I think managers worry it's a hassle to send the devices back, but it's really pretty painless," says Ms. Bennett. "Just put them into a collection bin and send them away. A few weeks later, get them back at half the cost of new blades."

Many of you don't agree. Less than one-third of the hospital and ASC facility managers we surveyed send their SUDs to a third-party reprocessor (see table on p. 59). Some believe that an SUD is just that. "If it says single-patient use, then we always dispose of it after one use," says Gail Kaufman, RN, BSN, surgical services nurse manager at Logansport Memorial Hospital in Logansport, Ind. Several others wonder, what good is saving money on supplies if your surgeons won't use them - or do so begrudgingly? One manager says her arthroscopic surgeons viewed reprocessed burrs and shavers as less than new. "They said they saw bits of metal floating in the joints from the reprocessed burrs," she says. Another calls reprocessing a hassle memorable only for too many failed reprocessed devices.

As good as new?
Reprocessing involves the total decontamination, refurbishing, testing, sterilization and packaging of once-used or opened and unused single-use devices. Reprocessing SUDs has been around for more than two decades, but questions and concerns persist over whether reusing SUDs is suitable and safe for surgical facilities. It's easy to see where the confusion comes in. Manufacturers of devices labeled for single use only suggest that you use each device only once and then throw it away.

But thousands of SUDs can be safely reprocessed and used again, as safe and as effective following reprocessing as they were as original devices. The FDA tightly regulates reprocessing of SUDs and several professional societies have tacitly endorsed the practice. Regarding safety, there's no proof in the literature that reprocessed SUDs have a higher infection rate associated with their use.

Third-party reprocessors will tell you that you shouldn't be able to tell the difference between using a new device or a reprocessed one. Even the packaging should be indistinguishable (although if you look closely, you'll notice that reprocessed devices are either marked with the reprocessor's name or logo, or otherwise bear a peel-away label that may be attached to the patient's chart). And in terms of functionality (from proper sharpness to spring actuation), cleanliness and sterility, a reprocessed device should be as good as new.

"We've had fewer problems with our reprocessed supplies than we've had with new supplies," says one administrator. "Very cost-effective, just like OEM, no matter what the vendors and manufacturers say," says another.

Tips for doing reprocessing right
If you're thinking about using a third-party reprocessor, here's advice for doing the job right.

  • Get your staff squarely behind the effort. Your staff can easily sabotage your efforts if it doesn't believe in the virtues of reprocessing. Appoint a "reprocessing czar or czarina" to quell the naysayers, suggests one reader. "Staff have a very difficult time understanding that you are not cheating the patient by charging for a reprocessed item like you charge for a new item," says a respondent.

    Staff will have to do a bit more work. You'll have to wash and disinfect and carefully pack instruments you plan to have reprocessed before you ship them out. To facilitate reprocessing, Kaeryn Frank, RN, CNOR, OR director for the SurgiCenter of Baton Rouge, found it helpful to keep two bins: one for devices that had been used and had to be cleaned and decontaminated, and another for opened but unused equipment. She says she typically sent items out once a month and received them back within 18 to 21 days, making sure to keep enough on hand to cover the three-week period. She also made sure to e-mail her packing slip, so she could check it against the invoice and packing slip. "Doing it all online meant I could go back and pull up any invoice I needed," she says.
  • What to tell surgeons and sales reps? You might have to educate your surgeons about reprocessing and defend your decision to reprocess to sales reps, who obviously won't be happy losing the business and will marshal arguments against it. Ms. Frank says she overcame these objections by educating physicians about how reprocessing works, and making sure to provide adequate quality assurance - by querying the doctors about any complaints - once her center began sending out instruments for reprocessing. Besides including your most active docs in the decision process, you might consider having your surgeons do a site visit to the reprocessing plant, say a few mangers.
  • You'll also face a good problem to have. That's figuring out what to do with all the money you'll save on your supply and, to a lesser degree, disposal costs (the landfills will thank you). "I tell staff that the money we save is their bonus money, and to consider the time they spend cleaning an investment that will bring rewards," says Ms. Frank. But keep in mind that actual results may vary from what a salesperson tells you. "Third-party reprocessors usually assess an organization's potential savings. Don't lose sight of the word 'potential' or you could be disappointed," says Anne Gragg, BS/HM, CNOR, director of the George Hancock Surgery Center, a division of Caldwell Memorial Hospital, in Lenoir, N.C. Ms. Gragg says her center has done well by reprocessing, but has yet to save as much as the reprocessor promised.

  • But those savings can be eaten up. What one administrator saved by reprocessing was offset by the higher prices she had to pay for new supplies for which she was on contract. Because she was reprocessing, her facility's purchasing volume dipped beneath the level she had to maintain to meet tier pricing. This same administrator warns that if you stock your reprocessed items with your new items, staff will pull the new items routinely.
  • Starting slow's the way to go. Approach reprocessing slowly and cautiously. "We started off with opened and unused items, because I saw that we were throwing away hundreds of dollars," says Ms. Frank. "Then we moved to expired items. As I started to see the savings, I got really excited and I started to look at such items as disposable tourniquets and SUD leggings. If I opened a case, and it was canceled, I salvaged everything." Another administrator sends her reprocessor only open but unused supplies - items that fell on the floor or were opened mistakenly and taken off field before an incision was made.
  • Vet the reprocessors. Probably the best way to find the best reprocessing firm for your center is to call around and see whom your colleagues are using. You're likely to find the companies that provide this service at the conferences you attend. "Talk to everyone, then query colleagues and see which names keep coming up," says Ms. Frank. Above all, she says, make sure the firm is FDA-registered. Verify that the reprocessor has met all FDA requirements for the OEM (original equipment manufacturer) of the product (be sure the 510k is on file) and is insured to limit your liability. In the end, your best bet may be to keep an open mind. As one manager we surveyed says, "I have heard good and bad, but would try to experience it myself to see firsthand."

The Limits of Reprocessing

' Not all SUDs are candidates for reprocessing. By some estimates, less than 2 percent of single-use devices are eligible for reprocessing. Depending on the capabilities of the reprocessor you choose, the list can extend to more than 8,000 different Class I and Class II SUDs in 15 major device categories. These devices include, but are not limited to, trocars, harmonic scalpels, laparoscopic instruments like graspers, forceps and cutting forceps, compression sleeves, RF arthroscopic electrodes, phaco tips and orthopedic bits, burrs and blades.

Items that aren't eligible include SUDs that can't be cleaned, sterilized or ensured to be functionally'equivalent to new devices. Some reprocessors won't reprocess Class III implantable devices. However, Class III devices are subject to FDA premarket approval requirements, which are much more arduous than Class I and Class II SUDs, says an industry source. Also not eligible: gowns, drapes, drains, Bovie cords, syringes, used battery-powered devices and devices with pressure cartridges.

' There's a limit to how many times a device can be reprocessed. Many SUDs can be reprocessed more than once, which can really decrease the per-use cost of the original item. The number of times an item can be reprocessed depends on many factors: device construction, material composition and handling by the clinician. Generally, the maximum number of times that a device can be reprocessed is five, meaning you'll get up to six uses out of the device (one new and up to five reprocessing cycles). A handful of device types don't survive the full five reprocessing cycles and are limited in the number of cycles that are permitted. The reprocessor, who must follow FDA regulations to remain licensed, will inspect what has been sent and determine the device's eligibility for reprocessing. If the device can't be reprocessed, a company representative will let you know so that you can replace the item. Most reprocessors will code cleaned devices to indicate reprocessing cycles and the number of times the device has been reprocessed.

- Deborah Grandinetti