saving dollars through innovative strategies in biohazardous waste reduction

2
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 McLaughlin Fort 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. Saving Dollars through Innovative Strategies in Biohazardous Waste Reduction J Keuchel* L Sholtz N Marion ME Rupp Nebraska 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 E32 Vol. 32 No. 3

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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*