Much modern medical equipment is labeled “disposable.” When resources are scarce, the luxury of not reusing serviceable medical equipment cannot be sustained. On the other hand, safety regarding equipment reuse is paramount. Patients should not be put at risk either through introducing infections from previously used equipment or by using malfunctioning equipment. This chapter discusses the guidelines and techniques for reusing, cleaning, and sterilizing medical equipment.
POLICIES ON REUSING MEDICAL EQUIPMENT
Major governments do not agree on their recommendations regarding the reuse of single-use devices (SUDs). The US policy across several agencies is that SUDs can be reused.
A US government panel of experts stated that in resource-scarce situations, equipment and supplies “will be rationed and used in ways consistent with achieving the ultimate goal of saving the most lives (e.g., disposable supplies may be reused).” However, they also said guidelines are needed on “how to use and reuse common supplies and equipment, such as gloves, gowns, and masks.”1
The US Food and Drug Administration (FDA) found “no data to indicate that people are being injured or put at increased risk by the reuse of SUDs,”2 while acknowledging that many SUDs are commonly reused. Among these are many types of equipment, including those used in dentistry, orthodontics, otolaryngology, and laparoscopy. Specific equipment includes needles, scalpels, forceps, trocars, saw blades, staplers, drills, scissors, masks, syringes, gowns, and biopsy devices.3 The problems found with reusing SUDs include a “loss of elasticity in inflatable balloons, persistence of blood and biofilms, loss of original lubricants and resultant effect on catheter threading, and crystallization of liquid x-ray contrast material.”3 The FDA recently advised that “single-use sterile devices that do not have reprocessing instructions should not be reprocessed.” They did not comment on resource-poor situations.4
The US Centers for Disease Control and Prevention (CDC) states that “in general, reusable medical devices or patient-care equipment that enters normally sterile tissue or the vascular system or through which blood flows should be sterilized before each use.”5 Except in rare and special instances, items that do not ordinarily touch the patient or that touch only intact skin are not involved in disease transmission and generally do not necessitate disinfection between uses on different patients. Special rules apply when patients are infected or colonized with drug-resistant or highly virulent microorganisms. In these cases, the CDC recommends that noncritical items be dedicated to one patient or patient cohort (someone with the same contagious illness) or that this equipment be subjected to low-level disinfection between patient uses. Reusable items that touch mucous membranes should, at a minimum, receive high-level disinfection between patients.5
The US Government Accounting Office (GAO) concluded that there is no evidence that reprocessed SUDs create an elevated health risk for patients. Testifying before the US Congress, Dr. Kenneth Kizer, a former undersecretary for health at ...