REUSE IN STERILE SITES OF SINGLE-USE MEDICAL DEVICES - HOW COMMON IS THIS IN AUSTRALIA

Objectives: To determine to what extent Australian hospitals reuse in sterile sites medical devices labelled ''single use only''; to assess the adequacy of cleaning and sterilising procedures before reuse; and to estimate the possible incidence of cross-infection and the costs of not reusing these devices. Design: A self-administered questionnaire survey. Setting: All Australian hospitals (419) with more than 45 beds and undertaking medical and surgical procedures. Methods: Questionnai res were sent to hospital infection control practitioners in 1994 requ esting information about reuse in sterile sites of single-use medical devices, the extent of reuse, the cleaning and sterilising processes i nvolved, and the reasons for reuse. Results: Responses were received f rom 168 hospitals (40%). Reuse occurred in 64 (38%), and another 33 ho spitals had been reusing medical devices 12 months before our survey ( i.e., 97/168 hospitals [58%] were either reusing them at the time of o ur survey or had been doing so 12 months previously). More large (> 30 0 beds) metropolitan public hospitals (9/14; 64%) reported reusing tha n did smaller (50/143; 41%) or private hospitals (15/47; 32%). At six of the 64 hospitals where reuse occurred, the process of cleaning and/ or sterilisation of these devices was not satisfactory; from the infor mation we received, both cleaning and sterilisation were satisfactory in only 38 hospitals (59%). Examination of the 14 most commonly reused devices showed that the structure of 13 of these may compromise clean ing (and therefore sterilisation). The main reason given for reuse was cost saving. Assuming a 2% prevalence of transmissible infections in blood, and an infection transmission risk of 1/500, we estimate that e ach year in Australia there may be 40 cases of cross-infection for eve ry one million procedures performed with reused devices (0.004%). Conc lusions: Reuse of medical devices labelled ''single use only'' is comm on in Australian hospitals. Most devices appear to be unsuitable for r euse. Complete cessation of this practice of reusing single-use medica l devices would stop potential cross-infection, but this would cost an estimated $2.5 million or more per case prevented.