saving dollars through innovative strategies in biohazardous waste reduction
TRANSCRIPT
and associated remodeling costs were approved by the Oregon Hospital Preparedness Advisory Committee in
October 2003 and funded by the Oregon Health Resources and Services Administration (OHRSA) cooperative
agreement. Using BSC specifications developed by the OSPHL microbiology department, a request for purchase
was submitted by the OHRSA in November 2003.
RESULTS: A BSC contractor was chosen through the state purchasing department in January 2004. The 12 BSCs
are being installed and certified and staff is being trained during the first quarter of 2004.
LESSONS LEARNED: From needs assessment to funding and installation, timelines for facilitating hospital
laboratory BSCs (and thus preventing infectious aerosol hazards to laboratorians) may take over 1 year.
Reprocessed SUDs: Cost-Savings without Undue Risk?
L George*D McLaughlinFort Sanders Regional Medical Center, Knoxville, Tennessee
BACKGROUND: The infection control professional and manager of central sterilization proposed that
reprocessing of single-use devices (SUDs) presented an opportunity to help control healthcare costs. A
multidisciplinary team identified four areas of concern: safety, liability, regulatory compliance, and calculation of
savings dependent on recycling compliance.
METHODS: Safety, liability, and regulatory concerns were addressed by requesting FDA information on SUDs-
related adverse events; proof of FDA and Quality Systems compliance from a third-party reprocessor; and
a protocol to track SUDs incidences. To maximize savings, consideration was given to FDA-approved noncritical,
semicritical, and critical devices; system-wide initiation; and executive review of financial reports. Assuming 90%
recycling compliance, the prior year’s cost-savings of $212,238 was determined with a formatted spreadsheet tool.
RESULTS: FDA search of SUDs-related adverse events indicated that there is no difference from originally
manufactured devices. According to FDA, the burden of liability is on the third-party reprocessor. To date, our
facility and third-party reprocessor report no adverse events related to SUDs. Actual facility-specific savings for
cath lab for March-December 2003 is $41,256; patient units for July-December 2003 is $22,575; surgery for
September-December 2003 is $5,417. Cumulative actual facility-specific savings is $69,248. Reprocessing is under
implementation throughout the multifacility system, with an estimated annual savings of[$1,000,000.
CONCLUSION: FDA database search evidenced that reprocessed devices are no different from original
manufactured. Including all approved devices, systemwide initiation and financial oversight maximized savings.
Reprocessed SUDs do not present undue risk and help to offset healthcare costs.
E32 Vol. 32 No. 3
Saving Dollars through Innovative Strategies in Biohazardous WasteReduction
J Keuchel*L SholtzN MarionME RuppNebraska Medical Center, Omaha, Nebraska
ISSUE: In August 2002, a multidisciplinary Biohazardous Waste Committee was organized to improve the handling
of biohazardous waste. An initial biohazardous waste audit revealed that approximately 90% of waste was
May 2004 E33
inappropriately characterized as biohazardous. Annual cost for disposal of over 722,000 pounds of biohazardous
waste exceeded $160,000.
PROJECT: The Biohazardous Waste Committee developed a campus-wide definition of biohazardous waste,
introduced barcode labeling for waste tracking, and performed waste audits to monitor disposal practice.
Committee representatives met with department managers to assess needs and optimize biohazardous waste
disposal. Mandatory education regarding proper handling of biohazardous waste was performed throughout the
facility. Customized improvements based on waste type, volume, and source (clinical versus research area) were
implemented in October 2003.
RESULTS: The December 2003 audit revealed biohazardous waste reduction in all areas, with significant unit-to-
unit variability. Overall, a 25% reduction in the institutional rate of biohazardous waste per census days was
realized.
LESSONS LEARNED: Since staff, clinical practice, and the healthcare environment varies, periodic waste audits,
data feedback, and ongoing education will be required to maintain biohazardous waste reduction. Significant
additional revenue savings are anticipated.
From Chaos to Consensus: A Collaborative Approach To Standardize thePlacement of Central Lines
N Shik*R PeruccaThe University of Kansas Hospital, Kansas City, Kansas
ISSUE: Central line-associated bloodstream infections (CL-BSI) lead to significant mortality and are estimated to
cost at least $25,000 per incident. Proper skin antisepsis and insertion technique are important steps to prevent
these infections. At the University of Kansas Hospital, a 454-bed academic medical center, central lines are
inserted by residents and attending physicians in many settings. Although CL-BSI rates were below NNIS mean
rates, observations by Infection Control found significant variations in central line insertion practices. Infection
Control and IV Therapy used a team approach to develop consensus standards based on 2002 HICPAC Guidelines
for the Prevention of Intravascular Catheter-Related Infections.
PROJECT: A committee was formed, with physician and nursing representatives from each setting in which
central lines were inserted. Meetings were held over a 4-month period to review the HICPAC guidelines.
Discussions were often heated, as different opinions were voiced. When questions arose, we reviewed studies
cited by HICPAC to ensure a science-based approach. New products were selected to support the
recommendations.
RESULTS: Written consensus standards, based on HICPAC guidelines, are now followed each time a central line
is inserted.
LESSONS LEARNED: This initiative was successful because important stakeholders were involved in the decision-
making process. Although it was difficult for each committee member to attend every meeting, email proved to be
an effective way to share information and opinions. Basing decisions on a review of the literature brought
credibility to the process and eliminated personal bias.
Biomedical Device-Associated Infections in Surgical-Critical Care Patients
B Grahn*