Much modern medical equipment is labeled "disposable." When resources are scarce, this luxury cannot be sustained. On the other hand, safety regarding reuse of equipment is paramount. Patients should not be put at risk either through introducing infections from previously used equipment or by using malfunctioning equipment. This section discusses the reuse, cleaning, and sterilization of equipment, including guidelines and techniques.
Major governments cannot seem to agree on their recommendations in trying to guide health care professionals in the reuse of single-use devices (SUDs). The United States' policy across several agencies is that SUDs can be reused.
A US government panel of experts stated that in resource-scarce situations, equipment and supplies "will be rationed and used in ways consistent with achieving the ultimate goal of saving the most lives (e.g., disposable supplies may be reused)." However, they also said guidelines are needed on "how to use and reuse common supplies and equipment, such as gloves, gowns, and masks."1
The US Food and Drug Administration (FDA) found that "no data to indicate that people are being injured or put at increased risk by the reuse of SUDs,"2 while acknowledging that many SUDs are commonly being reused. Among these are many types of equipment, including those used in dentistry, orthodontics, otolaryngology, and laparoscopy. Specific equipment being reused also includes needles, scalpels, forceps, trocars, saw blades, staplers, drills, scissors, masks, syringes, gowns, and biopsy devices.3,4 The problems they found with reusing SUDs include a "loss of elasticity in inflatable balloons, persistence of blood and biofilms, loss of original lubricants and resultant effect on catheter threading, and crystallization of liquid x-ray contrast material."4
The US Centers for Disease Control and Prevention (CDC) states that "in general, reusable medical devices or patient-care equipment that enters normally sterile tissue or the vascular system or through which blood flows should be sterilized before each use."5 Except in rare and special instances, items that do not ordinarily touch the patient or that touch only intact skin are not involved in disease transmission and generally do not necessitate disinfection between uses on different patients. Special rules apply when patients are infected or colonized with drug-resistant or highly virulent microorganisms. In these cases, the CDC recommends that noncritical items be dedicated to one patient or patient cohort (someone with the same contagious illness) or that this equipment be subjected to low-level disinfection between patient uses. Reusable items that touch mucous membranes should, at a minimum, receive high-level disinfection between patients.5
The US Government Accounting Office (GAO) concluded that there is no evidence that reprocessed SUDs create an elevated health risk for patients. Testifying before the US Congress, Dr. Kenneth Kizer, a former undersecretary for health at the US Department of Veterans Affairs, said, "Single-use labeling is a real scam for a lot of devices, and by not using reprocessed devices where possible, it is wasteful ...