On a recent trip to the US, I asked five or six hospitals what their policy was for dealing with packaged medical supplies (syringes, dressings etc) from the rooms of patients on precautions for MDROs. The response was startling: every hospital had a different policy. The policies ranged from 100% disposal of supplies for every discharge through a “toss heavy toss light” approach depending on the perceived risk of the patient to 0% disposal. I scoured international guidelines and, save a few organism-specific guidance documents, there is no direction on this issue in the guidelines.
What actually happens is another issue. Hospitals with a 100% disposal policy knew that staff often could not bring themselves to throw away perfectly good, sometimes fairly valuable items (IV sets and the like) for the small risk that the packaging may be contaminated. Some threw their supplies into “third world bins” to send to underprivileged hospitals, which is great, unless they happen to be contaminated with an MDRO that would survive the journey! Conversely, hospitals with a 0% disposal policy know that sometimes staff threw out the supplies if the patients had a high perceived risk of shedding. As for the “toss heavy toss light” hospitals: who knows what actually happens.
So, is there a real risk associated with contamination of the packaging of these items? A recent study by Johns Hopkins published in the recent ICHE special issue sampled a selection of supplies to quantify the risk, counted the cost of their current policy and found a potential solution in the use of hydrogen peroxide vapour (HPV) for the disinfection of the supplies. The study found that the packaging of 7-9% of supply items was contaminated with MDROs, and that hydrogen peroxide vapor (HPV) was effective for the disinfection of the supply packaging. The cost of supplies discarded from six ICUs amounted to almost $400,000, not including the costs associated with waste disposal. Hence, the practice of disinfecting the packaging of supplies using HPV would generate substantial cost savings.