Reuse of single‐use medical devices in sterile sites: how often does this still occur in Australia?

TO THE EDITOR: Single-use devices (SUDs) are in common use, and many are reprocessed. When examined, these devices are frequently not clean and have residual biological material on or within them.2-4,6 This material may contain viruses or other infectious agents. SUDs are usually made from plastics or other heat-sensitive materials resulting in less effective means being used for sterilisation than can be used for more robust materials — chemical disinfectants can be ineffective in the presence of organic material, and have poor penetration compared with heat (eg, an autoclave). In 1994 we found that, of 168 Australian hospitals reviewed, 68% were reprocessing SUDs used in sterile sites.1 We repeated this survey (using a similar questionnaire) in 2001, in acute-care hospitals with more than 45 beds. The questionnaire was sent to 461 hospitals — 181 private hospitals (117 with fewer than 100 beds, 59 with 100–300 beds, and five with more than 300 beds) and 286 public hospitals (115 with fewer than 100 beds, 116 with 100–300 beds and 55 with more than 300 beds). Responses were received from 189 (see Box 1). Not all respondents answered all questions and many responded anonymously. Reuse of SUDs still occurred in all states and territories, but compared with 1994 the rate had dropped to 15% (28 hospitals). Large hospitals reused more often than smaller hospitals (see Box 1). Reuse was slightly lower in private hospitals than in public hospitals (13% v 16%). Rural hospitals reused SUDs less often than metropolitan hospitals (12% v 16%). The commonest SUDs reused were diathermy pencils. Given their low cost ($5), the labour costs of reprocessing would exceed the cost of replacement. Diathermy pencils (Box 2) have spring-loaded buttons, which inevitably become contaminated with blood during surgical procedures. Thus, the potential exists to contaminate the surgeon’s fingers during subsequent procedures. We believe that reusing such relatively inexpensive items is inappropriate from both financial and infection control perspectives. An Australian National Health and Medical Research Council (NHMRC) report stated that, after reprocessing and packaging in hospitals, almost all SUDs were contaminated with foreign material (including blood), and several pacing electrodes had damaged insulation.6 Other studies have shown that blood persists on cardiac ablation catheters when structural abnormalities (which occurr frequently and early) are present.3 The reuse of these devices has been reviewed by the NHMRC and important changes have been recommended.6 Reuse of SUDs has been common in many countries. In the United States, reprocessing is frequent (eg, 2.5 million devices by one commercial reprocesser).5 In 2000, the US Food and Drug Administration issued a policy that, for practical purposes, should abolish the practice of reprocessing SUDs in hospitals. In Australia, the Therapeutic Goods Admin is t ra t ion recently announced that reprocessing of SUDs will be regulated.7 This should have a similar effect. As the methods and response rates of our two surveys were similar, we believe that the reuse rate has decreased. However, proportionately, fewer large public hospitals responded (only 13 of 55, or 24%, compared with 41% overall), even though they have the highest reuse rate (54%). Therefore, we are likely to have underestimated the actual rate of reuse. Also, those who are reusing may be less likely to admit to this practice, and thus less likely to respond. 1: Number and types of hospitals reusing single-use medical devices