Saving Lives and Saving Money Through Recovered Medical Equipment

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Saving Lives and Saving MoneyThrough Recovered
Medical Equipment
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MEDWorld Medical Equipment for the Developing
World Georgine Lamvu-Schooler, MD,
Director University of North Carolina
Hospitals Chapel Hill, North Carolina
Duke Recovers Daniel Burnett Duke University
School of Medicine Duke Hospital Durham, North
Carolina
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Overview

1. Why recover and donate medical equipment?
2. Success stories MEDWorld Duke Recovers
3. How to start your own recovery program

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1) Why Recover and Donate Unused Medical Supplies?
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People in Developing Nations Desperately Need
Basic Medical Supplies!
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Poverty in material resources is not matched
by poverty of intellect or resourcefulness and
improvisation and reuse are the rule Eyre-Brook
AL. Int. Orthop. 1986 105-10

• Wash and reuse gloves
• Substitute fishing line or thread for suture
• Patients bring their own supplies

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In the interest of optimal medical management
and protection from litigation U.S. hospitals
throw away millions worth of unused medical
supplies and equipment each year.
Each year UNC hospitals spends thousands of
dollars in medical waste disposal and storage.
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How do U.S. Hospitals benefit from recovery and
donation programs?

• 1993 study done by the Yale REMEDY program
  estimated that
• a nationwide recovery program could yield more
  than 193 million in charitable material and
  reduce operating room waste by more than 1.7
  million kilograms (1948 tons)
• Environmentally responsible alternative to excess
  waste
• Bring awareness to unnecessary disposal
• Improved staff morale
• Focus attention on the medical needs of
  developing countries and provides U.S.
  physicians, nurses and medical students with the
  opportunity to practice medicine overseas in
  clinics and hospitals serving the poor

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Ethical Issues

• Legal and regulatory standards in this country
  are unique to our legal and political climate-not
  all are necessarily essential for the provision
  of safe, effective patient care. Our culture
  assumes that replacements are uniformly
  available.
• Many donated supplies are critical and can be
  used in life-saving situations. Recipients are
  usually aware of the risk of recovery and
  resterilization.
• Donated material should be re-usable (NOT trash),
  safe and inspected prior to use by the recipients.

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Risk of Recovery and Resterilization

• Resterilization of disposable / single-use
  devices such as drainage
• bags anesthesia masks, surgical barriers and
  respiratory tubing is
• routinely done in developing countries.
• 41 of Canadian hospitals routinely resterilize
  and reuse disposable
• devices.
• The World Health Organization has recommended the
  resterilization
• of syringes and other disposable materials for
  the purpose of reuse
• in emergency relief efforts.
• To limit liability for the donors and risk to the
  recipient, medicolegal
• disclaimers should be used.
• Rosenblatt, WH. JAMA 1992 2681441-1443.

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2) Success Stories

• MEDWorld
• UNC Hospitals
• Duke Recovers
• Duke University Hospitals

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Medical Equipment for the Developing
World Georgine Lamvu-Schooler,
MD University of North Carolina Hospitals Chapel
Hill, North Carolina
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MEDWorld

• Founded in July 1999
• Modeled after Duke recovers and Yale REMEDY
• Started with 2 volunteers and a donation of two
  boxes
• MEDWorld is supported by
• UNC legal department
• UNC house-staff council
• UNC infectious diseases department
• UNC nursing department
• Medical Foundation of North Carolina
• UNC central distribution, shipping and
  receiving

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Present

• Non-profit volunteer organization with 6
  coordinators and over 20 volunteers
• In first 5 months MEDWorld shipped
• Over 9000 low grade surgical steel instruments
• Over 500 surgical drapes
• Over 600 pieces of gauze and 400 suture packs
• Over 400 gloves and gowns
• Average shipment 150 boxes (4 pallets) every 1-2
  months!
• Now shipping patient beds, neonatal incubators
  and other large outdated but functional equipment

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MEDWorld Operations
Medical supplies collected in operating rooms by
nursing staff.
Supplies placed in MEDWorld collection bins in
OR, LD and Ambulatory surgery areas.
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Recovered Supplies

• Surgical Instruments

• Gauze
• IV tubing
• Sutures
• Gloves
• Surgeon gowns
• Surgical drapes
• Suction tubing
• Tape
• Linens

Re-usable items are those which have been opened
but not used or have been contaminated by reasons
other than patient contact. All large equipment
must be safe and operational. Exposed sharps are
not recyclable.
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MEDWorld Operations
Medical supplies collected in MEDWorld bins by
volunteers and taken to Central Distribution.
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MEDWorld Operations
Supplies are inspected, sorted, inventoried and
packaged in cardboard boxes. Each box is labeled
with a disclaimer and recipient address.
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MEDWorld Operations
Boxes are stacked on pallets, shrink wrapped and
shipped receiving charities.

• MEDWorld receiving charities
• Little Samaritan Mission of Romania and Moldova
• Operation Renewed Hope
• Global Links
• Individual physician and medical student projects
• MEDWorld donates to over thirty countries around
  the world
• All recipients must demonstrate sterilization
  capability and proof
• of receipt

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MEDWorld Contributors

• Volunteer medical students, physicians and
  nursing staff
• University of North Carolina House Staff Council
• Wal-Mart
• Old Dominion Shipping
• Yellow Freight
• University of North Carolina Central Distribution
• Individual Donors

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Background

• Founded in February of 1997 by a medical student
  and a research technician.
• First program of its kind in the southeast.
• Began with 1 pallet/month, now often 2
  pallets/week.
• Saved duke hospital lots of due to feedback
  from inventory.

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Present

• Program consists of 10 volunteers and three
  coordinators.
• To date, have recovered over 1.4 million in
  supplies and have sent over 100 pallets overseas.
• Increased program awareness has resulted in
  larger recovery yields and focused donations.
• Operations expanding to satellite sites.

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So Far.

• Dr. Lamvu has illustrated a drastic need in
  third-world countries for medical supplies.
• Dr. Lamvu and I have both shown you examples of
  successful programs initiated at our respective.
• Institutions.

Now.

• I will detail how you can develop a similar
  program at you institution.

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3) How to Start Your Own Supply Recovery Program

• A Web-Based Tutorial

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Online Tutorial(http//www.duke.edu/web/gleaning)
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Basic Steps

• Design program
• Obtain approval
• Determine destination and arrange for
  transportation
• Set-up operations
• Continuing efforts

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Design Program
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Obtain Approval

• The most difficult step
• Persistence is key!
• Highlight benefits of program for the hospital

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Determine Destination and Arrange for
Transportation

• Use suggestions found on website.
• Charities are numerous and not hard to find.
• Make sure that charities have resterilization
  capabilities and safeguards against black market
  use.
• Freight may be a little more difficult, but
  alternatives include charities that do their own
  pick-ups.

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Set-up Operations

• Provide in-service training for those doing the
  recovery
• Recruit and train volunteers and coordinators-
  universal precautions
• Establish storage site(s)
• Develop routine for inventorying, packaging and
  shipping supplies

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Continuing Efforts

• Maintain a continuous volunteer base.
• Provide administration access to completed
  inventory sheets.
• Expand into different arenas.
• Increase awareness in hospital so outdated
  materials will be channeled to your program.

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Summary

• Your hospital could have an effective supply
  recovery program- there are currently 200
  programs in the U.S.
• Be persistent and follow steps outlined on the
  website
• Http//www.duke.edu/web/gleaning.
• If you need additional assistance, feel free to
  contact me- you CAN make a difference.

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Special Thanks To

• Duke and UNC medical students and staff
• Bill Dennis
• Dr. Jeff Wilkinson
• Dr. Anne Marie Connoly
• Wal Mart

• Duke Recovers
• Remedy
• Global Links
• UNC Central Distributions
• Old Dominion
• Yellow Freight