More surgical facilities are turning to third-party reprocessing of single-use devices to save money. One ASC manager we talked to projected an annual supply savings of $68,000 for her facility's first year alone. The Mayo Clinic has reported 50 percent to 70 percent savings on reprocessed devices, according to Marcia W. Parker, RN, MSN, CNOR, a clinical nurse educator, at University Community Hospital in Tampa, Fla.; she recently used this information to "emphasize the savings realized and to reinforce the need to continue putting SUDs in the recycle bin."

To realize similar savings, you need to understand the process and be realistic about your options. Then you can get staff and surgeons on board with the decision to turn disposables into reposables. The first thing you need to know: FDA approval to reprocess surgical devices is an arduous and expensive process; at roughly $100,000 a pop, obtaining a 510(k) is serious work.

"The reprocessor must submit the same paperwork a manufacturer would have to submit to the FDA to gain approval to manufacture and distribute a new device," explains Marcia Patrick, RN, MSN, CIC, the director of infection control for MultiCare Health System in Tacoma, Wash. The company must be able to prove it has a process for thorough cleaning, disinfection and sterilization of the device; that the process does not harm the device in any way; and that the device will function as a new one would, she says.

Perhaps that's why only three companies - Ascent, MediSISS and SterilMed - do such work (though many more perform high-level disinfection on non-invasive instruments). Further, Ms. Parker points out, more than 450 VHA organizations use reprocessing services.

Shop smart
Not all companies hold 510(k)s on the items you might want them to reprocess, says Ms. Patrick. There also might be some items that you decide aren't worth reprocessing because they're rarely used. The key, then, is to match up as many high-volume items as you can with a reprocessor's capabilities. Not only will this let you use just one vendor, which is cheaper, but it will also help your staff remember what goes into your vendor's bins.

Make a list of your FDA Class I and Class II SUDs and, rather than simply listing them from highest volume to lowest, make a four-column table in which you list the device, volume (monthly or annual), per-unit price and total cost (the price multiplied by volume). This will give you the best idea of where your biggest potential savings lie, say our experts. Work off that list as you shop for vendors, looking for one that can do your 10 or 20 biggest-ticket items.

Be sure that the company you choose stands behind its processes 100 percent, issuing a credit if you have problems with an item; provides either pick-up or free shipping; conducts in-services and continuing education on the SUD program; and makes available FDA paperwork on its certifications.

Trials, errors, success
If staff don't drop SUDs in the proper containers, they'll throw out potential savings and cost you extra, as you'll be paying for new SUDs and a reprocessing contract. Though UCH didn't get it right at first, says Ms. Parker, with tweaking and persistence, it reached its goal of 60 percent. Here's what worked - and what didn't.

• In-services. Ms. Parker's physicians and staff were skeptical at first, and each OR had a different collection method. The combination made for low compliance rates. UCH saw a modest boost when it did another round of in-services that included standardized collection methods, hallway displays and personal responses to all questions. "During the [first] year, we did several activities to increase staff awareness and encourage participation," says Ms. Parker. "We also had to convince the doctors that we were still giving them a quality instrument the second time around."
• Vendor support. With help from its reprocessor, UCH was able to present monthly compliance rates, graph-style, as well as offer an incentive. For every quarter with 60 percent collection compliance, the vendor would host an in-house party; the party would be off-campus for four quarters. Ms. Parker found that these longer-term rewards helped incrementally.
• Addressing problems. She designed a survey to identify staff concerns regarding SUD reprocessing; flyers posted in each OR department offered a $1 lottery ticket and a chance to win a $25 gift certificate to anyone who turned in a completed questionnaire. Ms. Parker tabulated survey results and presented them at an OR staff meeting that the vendor also attended. Detailed device lists and more collection bins were implemented at staff request. She investigated complaints about specific instruments such as scissors' not being sharp.

"With the exception of endoscopic scissors, which remain sharp only through one reprocessing, we have found that SUDs maintain their integrity throughout multiple reprocessings," says Ms. Parker. By demonstrating the efficacy of the reposables - but not being willing to overextend their use life - "acceptance has increased, as well as user satisfaction," says Ms. Parker.

• Tracking progress. To reap the benefits of tracking, data must be current, pertinent, department-specific and posted quickly; otherwise the positive effect of feedback will be lost. The vendor should provide you with volume and savings data at least monthly, says Ms. Parker.
• Field trip. If your in-house efforts aren't working, take your staff to see what happens to SUDs when they're reprocessed. This will help end the resistance.

Easy to be green
By retooling when needed and not letting up, UCH has seen compliance increase steadily to 63 percent - above its target. Along the way, staff have found another reason to participate: "The staff considers it a bonus that we're also impacting the environment by reducing landfill waste," says Ms. Parker.