American College of Physicians: Internal Medicine — Doctors for Adults ®

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A remedy for medical waste

Hospitals send unused supplies to needy facilities overseas

By Jessica Berthold

From the September ACP Hospitalist, copyright © 2008 by the American College of Physicians

What began as an idle conversation in a hospital break room a few months ago may soon save lives thousands of miles away.

John LeBow, DO, chief of staff at McKenzie-Willamette Medical Center in Springfield, Ore., was chatting with an operating room nurse who mentioned an interesting program she’d seen at other hospitals. The program, developed by a non-profit called REMEDY, Inc, collects opened but unused surgical supplies from U.S. hospitals to send to needy medical facilities overseas.

“I could see it was a tremendous opportunity,” said Dr. LeBow, who is now starting a REMEDY program at his hospital. “These are supplies that would normally go to landfills because they can’t be recycled, but which are greatly appreciated in other parts of the world.”

Supplies are certainly appreciated by the 325 children at L&A Memorial Academy in Accra, Ghana, a school that operates a medical clinic within its walls to serve students and their parents.

“We get gloves, syringes, gowns, gauze, and all kinds of assorted vials and tubes from U.S. hospitals,” said Japhet Aryiku, founder of the New York-based Adakum Educational Foundation, which acts as a go-between for the Academy and U.S. hospitals. “One day last year, I got a call that there were 32 boxes of sorted supplies for us at a warehouse in Connecticut, so I got a van, loaded it up and shipped everything to Ghana. It was amazing.”

A wide reach

About 600 hospitals currently work with REMEDY (Recovered Medical Equipment for the Developing World), a group that was started in 1991 by William H. Rosenblatt, MD, an anesthesiologist at Yale-New Haven Hospital who frequently volunteers for medical trips abroad.

REMEDY doesn’t send supplies directly, but instead helps hospitals set up standard procedures to recover supplies that have been “exposed,” often because they were prepared for medical procedures but never actually used (the FDA forbids U.S. hospitals from using these supplies again).

The supplies, which range from catheters and syringes to gowns and gloves, are sent all over the world, from Afghanistan to Nicaragua to Zambia, usually by U.S.-based charities that collect them from hospitals. Most hospitals already have staff who, for years, have collected supplies here and there for medical mission trips, said Tammy Young, executive director of REMEDY. Often these are operating room nurses, since they set up and break down after surgical procedures and are most aware of the supplies that go to waste, she said.

That was the case at Baystate Medical Center in Springfield, Mass., where hospitalist Jennifer Steichen, MD, helped start a REMEDY-based supply recovery program during her residency in 2002.

“The OR nurses were phenomenally receptive to the idea because they saw how much stuff was being thrown out day after day. A couple of them already collected supplies for themselves or others for when they went overseas, but they wanted to do it in a more organized and regular fashion,” Dr. Steichen said.

It took a long time to get the program up and running, Dr. Steichen acknowledges. She and two other residents had to convince various administrators that it was a good idea and that the program wouldn’t put the hospital or its staff at legal risk. They then had to decide where to store the supplies and from which areas of the hospital to collect, and talk to the staff involved. Finally, they had to pick a charity to receive the supplies.

“Finding a charity was probably the biggest obstacle. We didn’t have the funds to send the supplies directly, so we needed to find one that was willing to pick our supplies up and take them away,” Dr. Steichen said. “We ended up finding one by searching online and cold-calling hundreds of them.” To help make the process easier, REMEDY now maintains a database of nearly 1,000 non-profits that send or deliver medical supplies abroad as part of their mission, and that hospitals can approach about taking supplies, Ms. Young said.

“We can suggest groups in a hospital’s local area, or ones that provide aid to certain countries or in support of certain causes,” said Ms. Young, adding that REMEDY recommends against hospitals sending recovered supplies overseas themselves, as it is time-consuming and expensive.

Different hospitals, different approaches

REMEDY offers a teaching packet with guidelines on how to get a supply recovery program going at your hospital, but many facilities tailor the practices to their own needs. REMEDY’s protocols were originally developed for ORs, for example, but hospitals have adapted them for emergency departments, intensive care units, surgical centers, labs and even ambulances. At Duke University Medical Center in Durham, N.C., supplies come from the sterile processing department as well as the OR, said John Lohnes, a physician’s assistant in charge of supply recovery.

Duke volunteers pack medical supplies for shipment. Photo courtesy of Duke University.


Duke volunteers pack medical supplies for shipment.
Photo courtesy of Duke University.


“Our supplies include unused materials from the patient care areas, such as those packs outside the isolation rooms that include a gown, gloves, mask, hand foam cleanser, etc.,” Mr. Lohnes said. “We also get overstock and discontinued supplies from our materials management department.”

Most hospitals sort and package supplies themselves, but some places, like Baystate Medical Center, have this done by the intermediary charity. Rush University Medical Center in Chicago started a program in January that takes about five people to run, along with the occasional floating volunteer to help sort supplies, said George Hanson, a first-year medical student at Rush Medical College.

“It probably takes about four to five hours a week of my time, but once things are running more smoothly, I think it will decrease to one or two hours a week,” Mr. Hanson said. The hospital has also cut costs because of the program, according to Mr. Hanson. Although they do pay to ship the supplies to their charity in Atlanta, this has been more than offset by the $100,000 saved in costs for equipment disposal, he said.

When an intermediary charity covers shipping fees, the REMEDY program should only cost a hospital about $200 a year, said Ms. Young. That should cover the cost of the new paper bags in which supplies are transported to a sorting area and the detergent for items that need hand cleansing.

Another benefit of the program that can’t be measured in dollars is staff morale. Many hospital staff members want to participate in volunteer medical trips but can’t due to family or work obligations, and this is a way for staff to bond with one another on a global medical aid project, Ms. Young said. Getting the program off the ground can take considerable time and energy, depending on the hospital, but the rewards far outweigh the effort, Dr. Steichen said.

“You have to be persistent. Know that you are ultimately doing something good, and that even if you hit roadblocks, it all can be worked through,” Dr. Steichen said. “You really feel like you are doing something greater than yourself.”

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How to start a supply recovery program at your hospital

The following steps are adapted from the REMEDY In-Service Teaching Manual, which REMEDY makes available to hospitals upon request. For more information, go online.

  • Ensure administration’s support. REMEDY has publications and other materials, such as a letter supporting the program from the CEO of Yale-New Haven Hospital, that can help explain the program to administrators.
  • Recruit volunteers. Identify a core group, such as nurses, physicians and medical students, who can devote about an hour each week to the program. Then review information and procedures on subjects like legal issues and contaminated material handling with the relevant staff.
  • Identify a charity. REMEDY maintains a database of nearly 1,000 non-profits that ship medical supplies overseas.
  • Find space for sorting and storing. Yale-New Haven hospital uses a section of its warehouse for this. Other possibilities are a closet, a portion of a loading dock, an office, a garage or an off-site self-storage company.
  • Schedule training and start dates. Schedule an in-service with the nursing and technical staff to show a training video and distribute handouts. Then, set a date to start the recovery program. It may be useful to start small—with one or two ORs, or with one type of supply, like sutures—and expand from there.

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Supply recovery protocol

REMEDY’s protocol for recovering supplies in the operating room, listed below and in the group’s in-service teaching manual, can be modified for other areas of a health care facility.

  • Preparation: Paper bags are stored in the surgical supply room and placed on case carts by the supply room staffs, as these carts are prepared for the next day’s surgeries.
  • Primary sort: After a procedure, or upon cancellation of one, nurses and technicians place items that were opened but unused in the bags—except for sharps or damaged or contaminated materials.
  • Secondary sort: The bags are returned to the hospital decontamination area, along with other items from the OR like surgical instruments, and are placed in large, dedicated bins.
  • Tertiary sort: Volunteer staffers empty the bags onto trays and visibly inspect for unusable, contaminated or sharp items. The volunteers must follow exposure protocols, like wearing a gown, gloves and booties.
  • Decontamination: If required by hospital administration, items undergo decontamination, as with ethylene oxide.
  • Final sort: Materials are sorted by volunteer staff and put in shipping boxes.
  • Labeling and database: Boxes are individually labeled with one type of item per box, then inventoried by item type and weight. They are then either picked up by or shipped to a charity and noted in the shipping log, or stored for later donation to charity or for a volunteer medical trip.

Source: Adapted from the REMEDY In-Service Teaching Manual.

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Supplies that can be recovered

The following is a list of items routinely recovered via the REMEDY program at Yale-New Haven Hospital. (Source: REMEDY In-Service Teaching Manual.)

4 x 4 sponges
Absorbable hemostat
Absorbent towels
ACE bandage
Aortic cannula
Arthroscope drape
Burn dressing
C-arm drape
Cast padding
Cautery pad and pencil
Cherry sponge
Chest tube
Cone splash shield
Cover sponges
Disposable vascular clips
ETT
Extremity sheet
Femoral irrigation and suction tip set
Foley catheters
Heel protectors
Hemo clips
Hemovacs
Impervious split drapes
Intestinal sucker
Irrigation syringe
IV sets
Jackson-Pratt drain
Lap set 18 x 18, 4 x 18
Large drapes
Magnetic pad
Mucus trap
Open sponges
Open Sta-Tite
Paper towels
Partial lap 4 x 18
Peanut sponge
Penrose drains
Rolled gauze
Salem sump
Scalpel blades (no sharps exposed, foil intact)
Sets in-package
Skin graft carriers
Skin staples
Soft suction
Specimen container
Sponge packages
Staple remover
Steri drapes
Steri strips
Sterile gloves
Stockinet impervious
Straight catheters
Suction hose
Surgical gowns
Surgical paddies
Sutures (no sharps exposed, foil intact)
Syringes
Tape roll: cloth, paper
Telfa packaged tube and cord holders
Tissue stapler and refills
T-U-R-Y set
Urine culture tubes
Urine drainage bags
Urine meter
Vascular occlusion
Vaseline gauze
Wet pruf packaged Xeroform
Yankauer

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