Rethinking Reusables vs. Disposables in the Age of COVID

COVID-19 has changed the way surgery centers view disposables. Before the pandemic, disposables were a part of ambulatory surgical center (ASC) processes, but many reusable items were common.

Now, with increased threat of cross-contamination, ASC leaders will need to reevaluate and reassess their approach to disposable supplies. This will raise questions around safety for patients and staff, but also around cost and reimbursement.

1. Where to Put Your Disposables Focus: ASCs have a lengthy list of options to consider in their shift to disposables, but they'll need the most opportunity in pre-op. This includes items like ECG leads, oxygen sensors, IV start kids, blood pressure cuffs, stethoscopes, and temperature strips. Monitoring items are typically reused and wiped down between patients. But there are other opportunities too. Pre-COVID-19, most facilities used reusable laryngoscopes and laryngoscope blades, and even LMAs. These items are reprocessed by the facility between patients, but disposable options should be explored. In the OR, look at items like turnover kits that include disinfecting wipes, disposable sheets, stretcher covers, and pillow covers. Additional anesthesia filters are available as well. These items make it easier to keep environments clean because you're throwing away potentially contaminated items instead of trying to contain the contamination.
   
   
2. Making the Decision: Deciding which items to convert from reusable to disposable will require examining cleaning protocols and asking what works best for an individual facility and its risk factors. There are many situations where change may not be needed. For example, start by asking if your reprocessing practices are really as cost elective as using disposables. Outside reprocessing services, such as Cardinal Health's Sustainable Technologies business, might also be a more economical way to transition to disposables, especially for monitoring devices. These services reprocess devices, make sure they meet all manufactures specifications, and return them to the facility as a re-manufactured device at a reduced cost. Just a few months ago, nobody was thinking of reprocessing N-95 masks, but now the CDC has issued guidance for extended use and limited reuse. Facilities will have to rethink everything and make themselves aware of options.
   
   
3. Answering the Cost Reimbursement Questions: Costs are going to be critical for a while since so many facilities are still recuperating financially from being shut down. Many are still working with limited volumes because of the number of COVID-19 tests they're able to get for their patients and sta. Reduced schedules are also necessary to implement additional cleaning protocols and to prevent overcrowding in patient care areas. To address this, some facilities are extending their hours and even opening on Saturdays (which of course puts a strain on staff). At the same time, reimbursement remains the same as it was in the pre-COVID-19 environment. Additional infection prevention protocols, higher disposable use, and extended schedules have added significant cost in providing care. We don't know if CMS will adjust their rates to account for this increase in costs. We're also unsure of how third-party payers will respond since they've historically shown some preference for ASCs because of cost savings on their end.
   
   
4. Addressing Public Perceptions: Overall, I believe that increased use of disposables will be seen as a positive by the public. Patients will feel safer if they can see that their facility is being proactive about infection prevention and are taking tangible steps to improve their safety. While there will be an added level of strain because of supply chain issues (facilities will compete with the retail shops, businesses, and restaurants of the world for some PPE) it can still be an opportunity to enhance patient perceptions. Patients are much more aware of risks because of media exposure and many are asking whether their ASC is safe and what measures are being taken to protect them. This is especially true in at-risk populations like the older demographic groups having many ambulatory procedures. These groups might start actively looking at processes and the disposables that a facility is using as factors when choosing a provider. This will be a big shift for most ASCs, but keeping a focus on patient safety and making wise decisions will sustain them in the long term.