Are there really rules that require hospitals to throw away good supplies?

Factual Questions
1

(I think this was in the New York Times, but I can’t recall how it was worded to look it up.)
There’s a doctor that is starting a program of taking discarded medical supplies from his hospital and sending them to Africa so they won’t be wasted.
He claims that the government rules make him toss out any bandages left over in a box; that each new patient must start a new box. And similarly, that if there is a “kit” for some surgery procedure that has extra parts and tools, that he is required to throw them out. The pile of this perfectly good stuff is then a burden to get rid off, so the hospital was glad when he found someone to take it.
(He also arranged for used euipment to donated, like obsolete x-ray equipment. I can understand that one, as much obsolete equipment is probably idle but still working)

It seems strange, so I wonder if he is telling the whole story. Because if the supplies are really good, they could presumably be used in the US at free clinics, etc. And if they aren’t really good for some reason, then they should not go to other countries.

2

I’m guessing yes. I had my ileostomy removed in January and still have several unopened boxes of ileostomy equipment at home. I went to the pharmacy to ask if I could return them, but they wouldn’t take them as they’d left the pharmacy. That the boxes were still sealed didn’t matter, so I’m betting an opened box of anything at a hospital is discarded.

3

Most medical supplies have expiration dates, because sterility can’t be guaranteed forever. Also, sealed packaging may have been stored improperly, compromising sterility.
Some tools, (scissors and kelly clamps, for example) were once reuseable, but in recent years, have become disposable. It’s cheaper to throw them away, than to resterile them. I have a drawer full.

Surgical tools used in the OR, are still reused, because they remain very expensive to manufacture.

Sending supplies that are still usable to disadvantaged areas can be a life saver, but there are also horror stories about compromised items being used, causing harm.

There was a situation in Mexico where a doctor was coming to US border hospitals asking for used Swan-Ganz catheters to use as “teaching aids”. He was given several, which he then took back to Mexico, attempted to resterlize and used on critically ill patients. Since the catheters have such a small interior diameter, they are impossible to clean completely. Most of the patients died.
This went on for a couple months, before he was stopped.
I know this to be true, because I worked in one of the hospitals he trolled. I refused to give him any used equipment. My reasoning was, even if it was being used for teaching, they were contaminated. I didn’t want to find out some healthcare professional got Hepatitis because I turned over a dirty catheter.

Even though it seems to be wasteful, no one’s health or life should be put at risk to save a buck.

4

[QUOTE=Priceguy]
I’m betting an opened box of anything at a hospital is discarded.
[/QUOTE]

In my experience, that is exactly the case. Each time I’ve had a baby, I was told to take home the open packages of diapers, baby wipes, feminine pads, and all the other supplies.

One nurse told me that they don’t know if some new mom stuck a dirty, filthy hand into that pack of diapers (wipes, pads, whatever) to get a clean one, and they can’t take the risk of using a contaminated diaper on some other newborn. Makes sense.

5

When I worked at a wildlife shelter, all the hospital throw-aways were a great goodsend. It tended to be blue plastic goods and lots of clamps, scissors, etc., but, put to great use there.

6

Unfortunately, the pharmaceutical industry throws away a lot of perfectly good medicine too. For QC testing of a lot ready to be released to the market (so not expired, or stored in bizarre conditions to test stability) labs usually receive more than the exact quantity needed to test; in part because certain tests need to be always done from a fresh bottle (2 mL out of a 50 mL bottle? Use a new one anyways!) and also because if something goes wrong during testing (either a preparation error by the chemist, an instrument malfunction, or an unexpected result), it’s always good to have extra to re-test with without having to contact the warehouse and have them send over a brand new box of stuff. So often, for 4 analytical tests, I’d receive something like 6 x 5mL vials, but only use 3-4 of them. The rest, unopened, and perfectly good, go to trash. Often more: we got 30-40 vials for things packaged in 1 mL bottles, and we might only use 5 or 6 of them. There was an effort to arrange to sample only the minimum required for testing + repeats, but it still leads to a lot of waste.

Thing is, these perfectly good drug products might not yet be completely labeled (we do release testing, then they label/package the product, and we test again for identity confirmation), and there can be no guarantee to the patient that the product was not contaminated in some manner considering that it went into a lab and was handled by many people before being “recovered”. That risk of contamination, that risk to the patients, is just too big to make it worth while, no matter how desperately some poor area/country/human aid group needs that morphine or fentanyl or whatever else drug is in high demand.

It still sucks to throw all that out, though.

7

I’m confused.

Hypothetically, without drugs/supplies, 99 out of 100 people in <insert Third World Country here> will die from some various disease. By using “leftover” drugs/supplies, only 49 out of 100 will die from disease and 2 will die from infection, contamination or some other perceived risk from the leftover supplies. In the big picture, is that a problem?

I don’t condone selling or donating used equipment like in picunurse’s example. That’s just gross on about a hundred levels. But what’s the risk of using leftover stuff that our litigation-happy society won’t let the docs use?

8

Polio vaccines in Africa are still refused because everyone knows the pharmacutical companies used poison in the vaccines during the Polio vaccinations. Polio has escaped extinction because of it. The fact that the entire story is untruthful is really a dead issue.

Very little among the things that American hospitals don’t want to use are a good answer for a third world country to use. Sealed sterile drugs ready to be mixed with sterile USP normal saline are dangerous if there is no sterile USP normal saline available. If you cannot control the entire chain from donation to use, you are risking the eventual patient.

Me, in my own facility I won’t even use a folded towel that is in the wrong place. I get one from the place where towels are supposed to be, and put the lost one in the laundry.

Tris

9

[QUOTE=Ruby]
I’m confused.

Hypothetically, without drugs/supplies, 99 out of 100 people in <insert Third World Country here> will die from some various disease. By using “leftover” drugs/supplies, only 49 out of 100 will die from disease and 2 will die from infection, contamination or some other perceived risk from the leftover supplies. In the big picture, is that a problem?

I don’t condone selling or donating used equipment like in picunurse’s example. That’s just gross on about a hundred levels. But what’s the risk of using leftover stuff that our litigation-happy society won’t let the docs use?
[/QUOTE]

Just a WAG:

1000 doses of LifeSavingDrug are given to patients in ThirdWorldCountry. The doses are “leftovers” from the QC labs and hospitals. DrugCompany gets amazing PR, everyone loves them, their stocks go up, sales go up, YAY! for everyone involved.

10 patients get ill/die from contamination/infection that is shown to be directly caused by getting LifeSavingDrug. And, OMG Media Pile-up in the fact that these are LEFTOVERS!!! Americans (Canadians, Germans, whatever) didn’t want them, they weren’t safe enough for them, but they are OK to give to ThirdWorldCountry?!?! OMG EVIL DrugCompany! Testing things, treating the poor like Guinea Pigs! Bad PR for DrugCompany. Disastrous financial effects ensue.

OK, so I’m exaggerating quite a bit, but I don’t think it’s a totally unimaginable logic for the company to take on the issue. Companies are in it for the money, for the good PR and ability to market their meds for more money, and if they can reduce their risk of bad PR that’s a good thing. The companies I have worked for DO have programs in place to send medications to regions in need of them, but only a limited amount… probably just enough to look good.

There have been times where I have thrown out unlabeled vials in the lab, knowing what they were, but short of actually testing those specific vials, there really wasn’t much way to prove it. Unless it was a narcotic, once it’s in the labs, there really isn’t much need for chain-of-custody issues, so just because there are 50 vials in a plastic bag labeled “Gentamicin Sulfate, 40mg/mL Code XXXX Lot YYYYYY” that doesn’t mean that’s what’s actually there. Not with enough certainty to send those vials back to be labeled and used, anyways (there is enough certainty to test them and say lot YYYYYY is good, since testing it pretty much proves that it is gentamicin, obviously).

In case it isn’t clear, a lot might have several thousand vials made ( for simplicity, I’ll just say 5000), and 10 or whatever brought into the lab to test (unlabeled, but placed in the bag and verified that it’s the lot of interest). Once the test confirms that the lot is good, the 4990 vials left get packaged, and maybe 2 of those get brought to a lab to do identity testing (final proof that the vial contains what the label says it does). So 4988 vials can be sent to the market. Of the 12 vials in the lab, if there are 4 left, they might be valuable to someone in desperate need of them, but they really aren’t worth much to the company compared to the rest of the lot.

I still hated throwing them out, though.

10

As to “government rules”, perhaps that’s stating it backward. They don’t require tossing good items but prohibit charging for a full box if they retain some of it.
Medicare would not allow charging for a whole box of bandages if only two were used on the patient charged and two saved for the next guy. Since the hospital does not have prices for individual bandages they just offer the remainder to the first guy. He has no more use for them so they are left at the hospital, and are tossed.

However, it should be easy enough to control those odd lot bandages so they are not in the hands of disease ridden patients. Open the box in the supply room. There must be lots of supplies not used by the full packing case. So they could charge by the bandage if they were willing to.

So the OP problem is not one of sanitation but of accounting and hospitals being unimpressed by the problem. Like all conservation and recycling issues, once the source recognizes it as a problem a solution is obvious.

Perhaps, in the sea of hospital expenses, the bandages are looked at as too small a slice of the total to fuss over. And that’s true, patient by patient. Only when you are out behind the hospital watching the discard pile grow that you see the opportunity to conserve/

11

[QUOTE=Micro Dot]
Since the hospital does not have prices for individual bandages
[/QUOTE]

Hospitals certainly have prices for individual bandages, or at least they did when I worked for a health insurance company. I routinely saw hospital claims that included $1.98 for a single adhesive bandage and was mildly disugusted each time I saw it.

12

[QUOTE=Otto]
Hospitals certainly have prices for individual bandages, or at least they did when I worked for a health insurance company. I routinely saw hospital claims that included $1.98 for a single adhesive bandage and was mildly disugusted each time I saw it.
[/QUOTE]

The reason for that , is the wrap around cost. Bedside providers typically don’t itemize. so when you pay $1.98 for a Band aide™, you’re really paying $0.02 for the bandage, $0.20 for the stock person who brought it to the floor, $0.10 for the storage space, $1.00 for the doctor’s order and $0.66 for the nurse to put it on.

13

Just to add, I always try to collect all our labs supplies that we’ve kept past expiration dates, so I can send them back to my old college where students can use them. Reagents, old instruments, even gloves. Anything to save my old program a buck.

14

[QUOTE=MissGypsy]
… and they can’t take the risk of using a contaminated diaper on some other newborn. Makes sense.
[/QUOTE]

The risk? A contaminated diaper?? Am I being whooshed? In case you hadn’t noticed, diapers go on baby’s backsides. Backsides that for 99% of human evolution routinely sat on the bare earth without the human race dying out. Human babies are remarkably robust and I think the chance of their falling prey to some evil diaper bug transmitted through the buttocks is pretty slim.

Clearly the “sense” that this makes is some newly discovered form of paranoid sense.

15

[QUOTE=Hobohob]
(I think this was in the New York Times, but I can’t recall how it was worded to look it up.)
There’s a doctor that is starting a program of taking discarded medical supplies from his hospital and sending them to Africa so they won’t be wasted.
He claims that the government rules make him toss out any bandages left over in a box; that each new patient must start a new box. And similarly, that if there is a “kit” for some surgery procedure that has extra parts and tools, that he is required to throw them out. The pile of this perfectly good stuff is then a burden to get rid off, so the hospital was glad when he found someone to take it.
(He also arranged for used euipment to donated, like obsolete x-ray equipment. I can understand that one, as much obsolete equipment is probably idle but still working)

It seems strange, so I wonder if he is telling the whole story. Because if the supplies are really good, they could presumably be used in the US at free clinics, etc. And if they aren’t really good for some reason, then they should not go to other countries.
[/QUOTE]

There is a tremendous amount of waste in supplies for the US healthcare system and not much incentive to stop it. Suppliers like to sell and the healthcare system has a number of reasons to leave things the way they are.

In some sense it’s government and regulatory oversight (“rules”) but I like to remember that such oversight is a result, and not the cause, of those of us in the profession. We in healthcare are the final arbiters of the right thing to do and it’s our responsibility to make sure oversight agencies get their oversight right.

Some things have expiration dates. Drugs and supplies don’t go bad the day after the expiration date. These are discarded (sometimes to needy places) in perfectly acceptable condition.

There has been a trend toward disposable supplies. A suturing kit might have instruments which are very reusable, but the cost of managing and using a disposable kit might be less overall than the cost of buying higher quality instruments, tracking them, and sterilizing them. These “single-use” instruments are lower grade but still cleanable and reusable.

Some of the waste results because it is cheaper to discard supplies than to track usage. Some of it is just habit and convenience.

Considering how much food and clothing and energy and–well, you get the idea–we waste, I’m not sure it’s that much different than the rest of our culture.

In general when there is abundance, the lowest common denominator of the “I must have brand new” crowd is the easiest level to which we seem to cater.

16

The veterinary clinic I worked for used to get boxes of stuff from one of our clients who was a doctor and hated to see that kind of waste. Individually packaged sterile dressings and stuff like that. We loved it.

When I cut my arms rather badly a few years ago, my husband toted a good-sized bag of stuff to the car - enought that we didn’t have to buy any material for dressing changes and including a couple of pair of good metal bandage scissors and hemostats. Aren’t those autoclavable?

17

[QUOTE=SnakesCatLady]
When I cut my arms rather badly a few years ago, my husband toted a good-sized bag of stuff to the car - enought that we didn’t have to buy any material for dressing changes and including a couple of pair of good metal bandage scissors and hemostats. Aren’t those autoclavable?
[/QUOTE]
These days with our current knowledge of transmittable disease we tend to be over precautious. I don’t know if this is the case with your situation, but we are discovering contagious prions which are immune to even autoclaving.

Creutzfeldt-Jakob disease for example is one reason we defer blood donations from patients who have spent a lot of time in Western Europe. Hysterical, maybe, but so is disposing of perfecting good medical supplies.

18

[QUOTE=Colophon]
The risk? A contaminated diaper?? Am I being whooshed? In case you hadn’t noticed, diapers go on baby’s backsides. Backsides that for 99% of human evolution routinely sat on the bare earth without the human race dying out. Human babies are remarkably robust and I think the chance of their falling prey to some evil diaper bug transmitted through the buttocks is pretty slim.

Clearly the “sense” that this makes is some newly discovered form of paranoid sense.
[/QUOTE]
Many of those babies during 99% of human evolution did not survive, but could under modern circumstance. In today’s litigious society, it doesn’t make economic sense to save a dollar, but risk a million dollar lawsuit.

19

I worked as a “Central Services & Supply” technician at a couple of hospitals during my last few years of college and for a bit after graduating. One was the main hospital for many of the surrounding rural Northern California counties near my hometown, and the other was the Ohio State University Medical Center.

The folks I worked with handled a variety of duties: preparing the supply and instrument carts for scheduled surgeries, re-stocking the supply carts and supply rooms throughout the hospital, washing/decontamination of reusable instruments after surgery, sterilization and repair of reusable instruments, picking up patient charge slips for billing each day.

At the smaller hospital, they used a bar-coded sticker system for billing. Things like chux, and most basic dressings and bandages were billed to the individual hospital units. But everything else in our stockroom had an individual sticker item for each individual item. Every bag of Normal Saline IV solution had a sticker. Every catheter. Every disposable bedpan. I think they would’ve had us sticker every band-aid or individually packaged gauze pad if only the individuals stickers themselves didn’t cost more than the dressing.

A surgical patient was charged for all supplies included on their surgical cart, whether it was used or not, unless the surgical staff took the time to manually credit the patient’s bill for unopened/unused items (which most of them did, most of the time).

On the floors, any stickered items used in the care of a patient were accounted for by peeling the sticker off of the item and sticking it on the patients’ daily charge slips.

At OSU, their operations were massive in comparison, and the team I worked with was dedicated to only supporting surgery, so I don’t have insight into how they handled re-stocking. We packed carts for each surgical procedure with supplies and instruments. We cleaned up and re-sterilized the less-than-pristine consequences of the completed surgeries. We also cleaned and re-stocked the hospital’s supply of crash carts, sealing them with a plastic lock before sending them back out into circulation.

All that being said, the most wasteful things I ever saw in either hospital were due to emergencies combined with poor planning. Certain items can be available in an individually sealed package or as part of a sealed kit. If we ran out of the individuals, we would be asked to send up a whole kit that would be cracked open only to remove the individual item. Most of the doctors and staff I worked with were aware of the waste and tried to adjust the billing accordingly for the patient, but the remaining items in the kit would often have to be discarded, unless they could safely be gas-sterilized or something. The hospital basically ate that cost.

20

If a patient is billed for unused items from a kit aren’t they entitled to take those items home with them? :confused: