The Reuse of (Single-Use) Cardiac Disposable of Coronary Angiography and Angioplasty: Safety and Economic Issues in Gaza Strip

Background: Most countries outside the United States routinely reuse disposable medical equipment. We investigated the reuse of puncture needle, wires, sheath, manifold, inflation device, diagnostic and angioplasty catheters restored by a process strictly controlled for bioburden and sterility, in patients undergoing diagnostic coronary angiography and PCI.

Methods: We enrolled total 135 samples from different disposable (18 catheters, 6 manifold, 6 pressure line ,6 coronary wire, 6 femoral sheath, 2 inflation devices, 1 puncture needle) from 3 hospital in Gaza strip (45 sample from each hospital), were shipped to a central facility and were decontaminated, cleaned and tested for sterilization. The disposables were sterilized by exposure to Formaldehyde (90 samples,) or Cidex (45 samples) using a carefully validated protocol. Safety point: After sterilization disposables well rinsing with normal saline then taking swaps from outer side and inner side and were collected into a suitable container and transferred directly from collecting site to the laboratory to make culture. Cost-effective point: An average of five uses for diagnostic and three uses for angioplasty disposables.

Results: The disposable materials were collected from Aid Hospital and the European Gaza Hospital and sterilized by exposure to formaldehyde were negative results. while samples was collected from Al Shifa hospitals and sterilized by Cidex were 3 staphylococcus positive results. The procedure success rates similar to those of new products. Cost analysis suggests that An average of five uses for diagnostic disposables and three uses for angioplasty disposables may save approximately $5000 and $11500 respectively, per 100 procedures.

Conclusion: Reuse of medical devices labelled “single use only” is common in Palestinian hospitals. Restoration of disposable of coronary angiography and angioplasty using a controlled process appears to be safe, cost saving in sterilization by Formaldehyde (but not Cidex) with success rates similar to those of new products and no detectable sacrifice in performance.