Efficient use of Resources: Reprocessing of Single Use Devices at HCA (Hospital Corporation of America)


  • $17,600,000 in cost savings in 2010*
  • $21,700,000 in cost savings in 2011*
  • 296 tons of waste diverted in 2010*
  • 364 tons of waste diverted in 2011*
  • Process Improvement

The Problem

As hospitals transitioned away from cleaning and sterilizing much of their equipment the original equipment manufacturers (OEM) started providing single-use devices such as catheters and trocars to replace the reusable products previously employed. These OEM designated single-use devices increased the amount of waste a hospital generated and led to an increased cost. The appropriate reuse of these devices could result in both cost savings and waste reduction. Most of the OEM designated single use devices are disposed of as bio-hazardous waste, which further increases the cost of disposal and uses more resources for processing.

The Strategy Selected

In the late 1990s the FDA approved third party reprocessing of some OEM designated single-use devices. By making items available for reprocessing and purchasing and using reprocessed devices there could be a substantial diversion of waste from the waste streams. Making a commitment to reprocessing of OEM designated single-use devices, first in the OR and then elsewhere was the strategy selected to achieve these savings.

Implementation Process

The Team:

  • Environmental Services
  • Reprocessing vendor
  • OR Director
  • Materials Management
  • Sustainability Coordinator

A multi-faceted implementation approach was adopted. Different approaches were adopted for different audiences.

  • Facility Management -
    was briefed on the costs savings both from the use of reprocessed devices and from avoided waste disposal costs. With the CFO the emphasis was on the cost savings. Other members of facility management were briefed on both cost savings and environmental benefits. Once facility leadership became convinced of the appropriateness of pursuing this effort, others were brought into the process. Facility management was then responsible for appointing a project lead for this effort.
  • Physicians -
    A physician champion was identified. This physician ideally both is well regarded by peers and has a strong support for environmental matters. The environmental benefits were first explained to this physician. The physician was then provided with the studies showing no increased incidence of adverse outcomes through the use of reprocessed devices – including the 2000 and 2008 GAO reports finding little risk associated with the use of reprocessed devices. This physician and department leadership were used to educate other physicians and gain their acceptance. The reprocessing vendor also provided substantial resources which were used to educate physicians on the safety of reprocessing.
  • Employees -
    For facilities with an existing Green Team, the Green Team was used to champion this process as a waste reduction initiative. Otherwise, normal communication channels were used. It is extremely important to convey to employees the items which will be reprocessed in a clear and preferably visual manner. This increases the likelihood that all product identified for reprocessing is collected.

All stakeholders were consulted about the proper placement of the bins to receive the devices for reprocessing.

Challenges and Lessons Learned

OEM push back – Some OEMs were reluctant to lose the revenue represented by the decreased purchase of new devices. These OEMs engaged in informal lobbying of physicians and staff to prevent implementation of the program. The primary technique used was attacks on the safety of reprocessed devices. The resolution was two-fold, provide information from the selected reprocessing vendor on their steps to assure safety and provide the external reports by the GAO and others finding no issues with reprocessed devices. The 100% inspection rate for reprocessed devices, compared to the statistical sampling inspection for OEM devices was also pointed out to those expressing concerns.

Physician support – Despite identifying a physician champion, there were physicians who were reluctant to support the program. Data, reports and peer reviewed articles were the primary methods used to overcome this reluctance.

Lesson learned – start small – We found that implementation proceeded more smoothly if only some of the available devices were reprocessed initially and the reprocessing of all devices was phased in after an initial pilot period.

Demographic information

HCA is a leading provider of healthcare services, comprised of locally managed facilities that includes 163 hospitals and 109 freestanding surgery centers in 20 states and Great Britain.

*This information was supplied by the reprocessing vendor.

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