One of the tenets of our green practices is that recycling is great, but reuse is better. Reuse keeps items out of the waste stream and lessens the demand for the raw materials and energy needed to manufacture products in the first place. That's why we began reprocessing single-use devices. In 2008 the program saved us $496,123 and diverted 5.8 tons of waste from the landfill. Those are 2 big reasons why you need to add the practice to your instrument care routine.

Getting started
Begin by speaking with reprocessing firms in order to find the company most aligned with your needs, values and quality demands. Also talk with your GPO and other healthcare facilities in your area that work with reprocessors. It's important to work with a reputable firm because the FDA views the reprocessor as the "manufacturer" of the reprocessed devices. The reprocessor, not the original equipment manufacturer (OEM), becomes liable for any defects or quality issues.

After identifying a reprocessor, ask to visit their facility. (Whether or not they let you visit speaks volumes about the company.) When you do visit, look at the facility's cleanliness, the firm's processes and the staff's professionalism. A representative from the reprocessor should also visit your facility, explain how the program works and identify the devices in regular use that you'll be able to reprocess. Expect to pay your reprocessor a start-up fee (we paid $4,200). Also look for cost-saving opportunities. Our reprocessor provides device collection containers, which let us avoid buying 18-gallon sharps containers at $19 each.

The success of a reprocessing program depends on the quality of the firm you partner with. The FDA recommends asking your reprocessor the following questions:

• Has the reprocessing facility been inspected by the FDA?
• Can you provide documentation showing that the FDA has approved the firm to reprocess single-use devices?
• Which aspects of the process — cleaning, packaging, sterilization — have been validated?
• Do you have limits on how many times items can be reprocessed?
• How are those limits determined?
• How do you make sure items are not reprocessed too many times?

FDA inspection routines for reprocessors are as stringent as those for OEMs in order to ensure that their processes make the devices they market of equal quality to OEM devices. Once your reprocessing program is running, monitor the quality of the items you use. If you hear from surgeons or staff that certain products have poor quality issues — dull scalpels or scissors, for example — follow up on the reports. Check with the end users of the products and then contact the reprocessor. If the quality of a certain product continues to be an issue, stop purchasing that product.

Breaking the barrier
Reprocessing single-use devices has been controversial for several years because many manufacturers have labeled their products "single use only," and some hospitals have reprocessed single-use devices on site, which is now rarely done. Since 2000 the FDA has regulated reprocessors, holding them to the same quality, tracking and adverse event reporting standards as the original device manufacturers.

Still, be prepared to encounter a psychological barrier of concern between yourself and physicians and staff when you first discuss reprocessing single-use devices. You'll have to reassure them. Tell them that reprocessed products go through a FDA 510(k) process that requires documentation of how the reprocessing works and how the safety and quality of the remanufactured device will be equal to that of an original device.

Tailor your discussion of reprocessing to the different stakeholders involved in the process. Surgeons will have concerns about the quality of the instruments and their professional credibility when they're associated with a facility that reprocesses single-use items. Nurses will have infection control concerns and will want to know about changes in medical waste disposal practices. You'll need to discuss with environmental services how material will flow from collection containers to on-site storage receptacles to the reprocessor. Let staff or surgeons speak directly with the reprocessor, if necessary. Ask the reprocessor to supply quality and safety data that can inform surgeons and staff and ease their concerns.

Spread the word
Make sure that everyone in your facility understands your sustainability goals and how reprocessing single-use devices fits into the program. In our hospitals, we strive to reduce the number of devices in the medical waste that we send to the landfill. We redirect the savings from reprocessing toward patient care quality initiatives and distribute our working used equipment to hospitals in developing nations around the world.

For us, reprocessing single-use items has been a huge success. We plan to expand the program beyond surgical services to other departments, where we can continue to reduce waste and save money. We'll work with department managers so that they understand how reprocessing single-use devices can play a big part in reducing the amount of medical waste they generate without compromising safety or quality. Sustainability in health care demands looking at how scarce facility resources are fully utilized and then disposed of in order to produce the best possible care while minimizing the negative impact on the environment.