Saving Lives and Saving Money Through Recovered Medical Equipment

1. Saving Lives and Saving MoneyThrough Recovered Medical Equipment

2. 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

3. Overview • Why recover and donate medical equipment? • Success stories: MEDWorld & Duke Recovers • How to start your own recovery program

4. 1) Why Recover and Donate Unused Medical Supplies?

5. People in Developing Nations Desperately Need Basic Medical Supplies!

6. “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; 10:5-10 • Wash and reuse gloves • Substitute fishing line or thread for suture • Patients bring their own supplies

8. 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.

9. 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

10. 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.

11. 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; 268:1441-1443.

12. 2) Success Stories MEDWorld UNC Hospitals & Duke Recovers Duke University Hospitals

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

14. 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

15. 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

16. MEDWorld Operations Medical supplies collected in operating rooms by nursing staff. Supplies placed in MEDWorld collection bins in OR, L+D and Ambulatory surgery areas.

17. 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.

18. MEDWorld Operations Medical supplies collected in MEDWorld bins by volunteers and taken to Central Distribution.

19. MEDWorld Operations Supplies are inspected, sorted, inventoried and packaged in cardboard boxes. Each box is labeled with a disclaimer and recipient address.

20. 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

21. 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

23. 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.

24. 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.

25. 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.

26. 3)How to Start Your Own Supply Recovery Program A Web-Based Tutorial

27. Online Tutorial(http://www.duke.edu/web/gleaning)

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

29. Design Program

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

32. 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.

33. 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

34. 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.

35. 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.

36. 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 Special Thanks To: