Nurse Base

In his well-written and informative article "Reduce--recycle--reuse: guidelines for promoting perioperative waste management" (Vol 85, April 2007), Gary Laustsen, PhD, APRN, BC, has overlooked reference to two relevant in vivo studies on the use of reusable items. In one, the authors reported that they were able to reduce the generation of one category of items in red bag waste by replacing the items with reusables. Another reported on the economic effects of using reusables compared to their disposable counterparts.

In the first study, (1) surgical waste was examined from 27 procedures, including surgeries

* of the abdomen, including exploratory laparotomy, lysis of adhesions, vagotomy, partial colectomy, and cholecystectomy; and

* of the joints, specifically arthoplasties of the hip and knee, including total joint replacements and ligament repair.

The surgical waste generated weighed 610.5 lb (274.7 kg) and occupied 171.6 cu ft (5.1 [m.sup.3]). Disposable, single-use "linens" accounted for 39% of the weight; paper, 7%; plastic, 26%; and miscellaneous waste, 27%. By volume, the disposable, single-use linens and paper accounted for 69%; plastic, 23%; and miscellaneous waste, 7%. The authors concluded that by using reusable linen products and engaging in available recycling methods, weight reductions of 73% and volume reductions of 93% in surgical waste are possible.

In the second study, (2) the researchers compared the costs of two New Jersey teaching hospitals; Hospital A used only disposable OR scrub suits, and Hospital B used reusable apparel. Comparing annual costs of purchases for both types as well as disposal of single-use items and reprocessing of reusables, they found that the use of reusables resulted in an annual savings of $119,984 over the use of disposables. Though Hospital A performed two-thirds as many procedures as Hospital B, it spent 336% more on OR attire. In their conclusion, the authors observed that

it is inappropriate for hospitals to place pressure on physicians
to practice fiscal austerity in patient diagnosis and treatment and
then to waste dollars on the expensive conveniences of modern
"disposable" society. (2 (p656))

Another article on the processes involved in the generation and management of regulated medical waste was published a number of years ago. (3)

As described by Dr Laustsen, waste management processes should include systematic planning by a diversified group of health care professionals. Goals should include establishing a practical and understandable policy, standardizing waste container usage and location, increasing the knowledge and motivation of employees, and controlling costs.

In the final analysis, there is no question that disposables generate more waste than do reusable items. The amount of red bag medical waste can be reduced by judicious use of reusable items. Perhaps a mix of reusable and disposable products will prove to be the optimal choice.