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Peter J Collignon, Elaine Graham and Dianne E Dreimanis
Published by The Medical Journal of Australia 6 May 1996
Abstract
Objectives: To determine to what extent Australian
hospitals reuse in sterile sites medical devices labelled "single
use only"; to assess the adequacy of cleaning and sterilising
procedures before reuse; and to estimate the possible incidence of
cross-infection and the costs of not reusing these devices.
Design: A self-administered questionnaire survey.
Setting: All Australian hospitals (419) with more
than 45 beds and undertaking medical and surgical procedures.
Methods: Questionnaires were sent to hospital
infection control practitioners in 1994 requesting information
about reuse in sterile sites of single-use medical devices, the
extent of reuse, the cleaning and sterilising processes involved,
and the reasons for reuse.
Results: Responses were received from 168 hospitals
(40%). Reuse occurred in 64 (38%), and another 33 hospitals had been
reusing medical devices 12 months before our survey (i.e., 97/168
hospitals [58%] were either reusing them at the time of our survey or
had been doing so 12 months previously). More large (> 300 beds)
metropolitan public hospitals (9/14; 64%) reported reusing than did
smaller (50/143; 41%) or private hospitals (15/47; 32%). At six of the
64 hospitals where reuse occurred, the process of cleaning and/or
sterilisation of these devices was not satisfactory; from the
information we received, both cleaning and sterilisation were
satisfactory in only 38 hospitals (59%). Examination of the 14 most
commonly reused devices showed that the structure of 13 of these may
compromise cleaning (and therefore sterilisation). The main reason
given for reuse was cost saving. Assuming a 2% prevalence of
transmissible infections in blood, and an infection transmission
risk of 1/500, we estimate that each year in Australia there may be 40
cases of cross-infection for every one million procedures performed
with reused devices (0.004%).
Conclusions: Reuse of medical devices labelled
"single use only" is common in Australian hospitals. Most devices
appear to be unsuitable for reuse. Complete cessation of this
practice of reusing single-use medical devices would stop potential
cross-infection, but this would cost an estimated $2.5 million or
more per case prevented.
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