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At least 19 recordsLinked to original sources
PubMed1997

Patient acceptance of reused angioplasty equipment.

The reuse of percutaneous transluminal coronary angioplasty (PTCA) balloon catheters has recently been proposed as a way of containing costs. Our aim was to examine patient acceptability of this strategy. We asked 100 consecutive patients scheduled for potential or definite PTCA whether they would permit the use of sterilized, reused balloon catheters. We collected demographic, clinical, angiographic, and insurance-status data on all patients. Sixty-eight patients responded that they would have allowed reused equipment (group 1). Thirty-two patients would have refused (group 2). Only three group 2 patients could be enticed to change their opinions by appealing to their altruism or self-interest. The two groups of patients could not be distinguished by any variable, including insurance status. We conclude that a sufficient number of patients would be willing to permit reused PTCA equipment for such programs to be implemented successfully from a logistic standpoint. However, the disapproval by one third of patients raises the possibility of adverse publicity and litigation for institutions using such strategies.

Altruism↗
PubMed1994

Injecting risk behavior among drug users in Amsterdam, 1986 to 1992, and its relationship to AIDS prevention programs.

OBJECTIVES: Serial, cross-sectional trends in injecting risk behavior were studied among drug users from 1986 to 1992. METHODS: From a cohort study in Amsterdam, 616 intake visits of drug users who had injected in the 6 months preceding intake were selected. RESULTS: The proportion of drug users who reported borrowing and lending used injection equipment and reusing needles/syringes (in the previous 6 months), continuously declined from 51% to 20%, from 46% to 10% and from 63% to 39%, respectively. In multivariate analysis, it appeared unlikely that a selective recruitment of participants over time was responsible for these trends. Participants, recruited later in time, had been previously tested for human immunodeficiency virus (HIV) more often, had received daily methadone less often, and had obtained a higher proportion of new needles via exchange programs. Indications were found that (1) voluntary HIV testing and counseling leads to less borrowing, lending, and reusing equipment; and (2) obtaining needles via exchange programs leads to less reusing needles/syringes. It appeared that nonattenders of methadone and exchange programs have reduced borrowing and lending to the same extent as attenders. CONCLUSIONS: Methodologically, evaluating specific measures is difficult. However, the combination of various preventive measures in Amsterdam is likely to be responsible for the observed decrease in injecting risk behavior.

Acquired Immunodeficiency Syndrome↗
PubMed1978

Mortality and morbidity of reusing dialysers. A report by the registration committee of the European Dialysis and Transplant Association.

The practice of reusing dialysers in renal units in the UK was surveyed by examining the patient questionnaires returned to the EDTA registration committee for 1976 and by a special questionnaire sent to all UK renal units. Altogether 65.6% of the 1785 patients treated with non-disposable dialysers and 49.6% of the 1109 treated with disposable dialysers reused their equipment. Reuse of dialysers caused some morbidity but no mortality. Most centres where disposable dialysers were used accepted that their reuse was necessary because of financial constraints and was ethically defensible.

Adolescent↗
PubMed1998

"Single-use" needles and syringes for the prevention of HIV infection among injection drug users.

Providing single-use injection equipment to persons who inject illicit drugs would appear to be an effective method for reducing HIV transmission. However, interviews with manufacturers, syringe exchange program staff, and drug users revealed numerous difficulties with such a technologic solution. All designs for such equipment can be defeated and should probably be called difficult-to-reuse equipment. There are problems with consumer acceptance of difficult-to-reuse equipment and with safe disposal of large amounts of biohazardous waste. Despite these problems, it would be useful to conduct additional research, particularly on the potential for placing difficult-to-reuse equipment into shooting galleries.

Australia↗
PubMed1999

Reuse of angioplasty catheters and risk of Creutzfeldt-Jakob disease.

BACKGROUND: In 1996, the Quebec Ministry of Health and Social Services, concerned that reuse of devices contaminated with blood or blood products could cause the transmission of Creutzfeldt-Jakob disease (CJD), discontinued its practice of reusing angioplasty catheters despite the significant cost savings reuse had afforded the health care system for several years. The objective of this study was to establish whether the medical literature provides documentation of any cases in which CJD was transmitted by reused percutaneous transluminal coronary angioplasty (PTCA) equipment. METHODS AND RESULTS: A Medline search was performed to identify previous studies that examined this issue. Key words for the search included PTCA, CJD, and material and equipment reuse. A substantial amount of effort has been spent on the study of PTCA catheter reuse in relation to the risk of infection, toxicity, and catheter breakage as well as cost. In Québec, studies by the Conseil d'Evaluation des Technologies de la Santé investigated the effectiveness of cleaning and sterilizing PTCA equipment and considered the possibility that reuse of single-use catheters, hemodialyzers, and cardiac pacemakers could spread CJD. A number of other studies found evidence that iatrogenic transmission was responsible for several cases of CJD by direct implantation in or adjacent to the central nervous system during neurosurgery. CJD was also transmitted to human beings by injection of pituitary growth hormone and to mice through cerebral inoculation of contaminated blood and urine. However, there were no documented cases of CJD occurring as a complication of PTCA equipment reuse. CONCLUSIONS: The current literature indicates that there are no known cases of CJD attributable to the reuse of PTCA devices contaminated by blood or to the transfusion of blood or blood products. This practice is associated with a very low risk of CJD transmission. With the considerable cost savings made possible by reuse of PTCA equipment, reimplementation of this practice should be considered by health delivery systems, provided that stringent methods of cleaning and sterilization are observed.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

The risks of reuse: legal implications for hospitals of reusing single-use medical devices.

There is no doubt that the practice of reuse in hospitals is a reaction to the budgetary constraints under which hospitals are operating. However, the costs of appropriately monitoring and sterilizing reused equipment as well as the significant risk of patient harm and potential liability raise the unavoidable question of whether this practice is an advisable one. These costs and risk should be carefully examined before a decision about whether to reuse single-use devices is made.

Canada↗
PubMed1997

A prospective study of the repeated use of sterilized papillotomes and retrieval baskets for ERCP: quality and cost analysis.

BACKGROUND: The impact on instrument quality and cost of the practice of reusing ERCP accessories has not been fully addressed. METHODS: Twenty-five new papillotomes and 15 new retrieval baskets were labeled and evaluated over time by staff blinded to the number of prior uses. Instruments were scored as to their function for the designated task. The cost of this practice was calculated from the purchase price of accessories and the costs of cleaning, sterilization, and disposal, and then compared with the estimated cost of a practice of one-time use of similar instruments. RESULTS: Twenty-five papillotomes were used 246 times (median 8; mean 9.8). Fifteen retrieval baskets were used 193 times (median 13; mean 12.9). The median survival of both papillotomes and baskets before being considered inadequate (score < 6 out of 10) was 9 uses. There were no complications attributable to using reused equipment. The projected yearly cost savings of using reusable versus disposable instruments was $94,095 for papillotomes and $61,809 for baskets, a 475% and 322% cost reduction, respectively. CONCLUSION: The papillotomes and baskets in this study could be reused reliably and safely multiple times, with considerable cost savings compared with the practice of using disposable instruments.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1998

[Unintended events in anesthesia due to reuse of disposable equipment].

Two cases concerning reuse of plastic-coated introducers (intended for single-use only) for intubation of children are described. If breaks in the coating occur, the airway can be compromised and removal of the broken piece of the plastic-coating can the treacherous. In this paper, the probable causes of the incidents are discussed and suggestions for avoiding breakage are outlined.

Anesthesia, Inhalation↗
PubMed1998

How many times can you reuse a "single-use" sphincterotome? A prospective evaluation.

BACKGROUND: The decreasing reimbursement for endoscopic supplies has prompted evaluation of reuse of "single use" items. METHODS: Over a 12.5-month period, numbered sphincterotomes were used for sphincterotomy or as a diagnostic catheter in all patients undergoing endoscopic retrograde cholangiopancreatography. Before first use and after each subsequent use, the resistance of the sphincterotome was measured with an ohmmeter. After each use, the sphincterotome was thoroughly cleaned and gas sterilized. Sphincterotomes that could not be adequately cleaned or would not function properly were discarded. The endoscopist was blinded to the number of prior uses of the sphincterotome. RESULTS: During the study period, 80 sphincterotomes were used 290 times, including use in 162 sphincterotomies. The median number of uses before discarding was 3 and ranged from 0 to 10. The single most common reason for discarding the sphincterotome was breakage of the wire to the handle which occurred after 1 to 9 uses. The sphincterotome did not cut inappropriately in any patient, and no complications were linked to reuse. Equipment costs to our unit were reduced $21,000 by reuse. CONCLUSIONS: "Single use" sphincterotomes can be safely reused multiple times without compromising their use as a diagnostic or therapeutic device.

Cholangiopancreatography, Endoscopic Retrograde↗