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Role Redesign
SEPTEMBER 1995, VOL 62, NO 3 LETTERS
port AORN’s position on waste ROLE REDESIGN generation.’ his letter is in response to the Approximately 15% of this July “President’s Message” “Unsubstantiated assumptions country’s annual medical waste (ie, about unlicensed assistive person- 480,000 tons) is labeled infectious. nel obscure the challenge of deliv- At the 1990 incineration rate of 50 ering quality patient care.” I think cents per pound for infectious the public should be informed that waste, the annual cost to the US health care system was unlicensed assistive personnel are taking over for RNs and technolo- $480,000,000.2Medical waste, therefore, cannot be considered gists in the OR. Then the public insignificant-in dollars or envican decide if it wants someone ronmental impact. who has been trained for two It is possible to reduce medical weeks or someone who has been waste by choosing reusable prodtrained for two to four years to ucts, Surgical departments, which take care of them. generate 50% of hospital infectious Registered nurses have an waste? are a good place to begin. extensive education in the pathoOne hospital reported achieving physiology of diseases with intersurgical waste weight reductions of ventions and treatments. I believe if the public had a choice of some- 73% and volume reductions of one with an extensive educational 93% by replacing disposableproducts with reusables.4 background over someone with a Our nation’s environmental limited skills course, the answer problems are not new; they reprewould be obvious. As for cutting costs, hospital administrators have sent an accumulation of misuse, mismanagement,and mistakes that experts who can delineate other are not going to disappear. wasteful hospital expenses that can be cut so that skilled, educated Today’s concerns are accompanied by a clear and distinct mespersonnel can be retained to offer sage-we simply can no longer appropriate patient care. LOREllA M. RAVEN afford the luxury of using someRN, BSN thing once and then throwing it STUDENT away. COLLEGE MISERICORDIA NATHAN 1. BELKIN PHD D a m , PA CLEARWATER, Fu REDUCE REUSE, RECYCLE TALC POUDRAGE n their July article “Estimating the true costs of disposfound the July article “Talc poudrage for treatment of able and reusable instruments,” the authors comment that pleural effusion in selected hospitals generate only 2% of the patients” by Isabelita C. Tampinco-Golos, FW,BSN, timely, and it total municipal waste and that answered many questions I had disposable surgical drapes and gowns represent less than 2%of about the procedure. I was impressed with the author’s insight hospital waste. They logically and knowledge-right up to the conclude, therefore, that “2% of paragraph on talc sterilization. 2%is insignificant compared to Talc sterilization has been a hot total municipal waste.” This statement does not appear to sup- issue for several years because talc
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333 AORN JOURNAL
cannot be sterilized by ethylene oxide (EO) or by steam. Talc repels water, a fact that was not directly referenced by the author. An EO sterilization process depends on the moisture in the cycle. Please correct this misinformation or publish some scientific evidence that confms that what we have assumed all these years about talc and EO is incorrect. If EO penetrates talc, many people will be thrilled-and the company advertising an expensive dry-heat oven for sterilizing talc will be acutely disappointed. CAROL BALL RN, BSN, CNOR, CSPDT, RCST CENTRAL PROCESSINdLINEN DIRECTOR, THEVALLEY HOSPITAL RIDOEWOOO, NJ
Clinical editor‘s response. My research concludes that you are correct (ie, there are no known data to support talc sterilization using EO). We cannot, therefore, conclude that EO is an effective or desirable method for sterilizing talc. A dry-heat sterilization method is the only method that has been validated as an effective sterilant for p o ~ d e rOne . ~ company has performed an internal study that demonstrates the effectiveness of using a fully jacketed sterilizer (ie, with steam to the jacket only) to sterilize the powder. The sterilizer walls emit heat to stimulate the dry-heat method of sterilization.6 The author of the article about talc poudrage treatment did not have this information at the time her article was published. In addition, the author’s institution contracted with an industry source to sterilize the powder used in talc poudrage procedures. We were unable to obtain information from this industry source to verify the effectiveness of
port AORN’s position on waste ROLE REDESIGN generation.’ his letter is in response to the Approximately 15% of this July “President’s Message” “Unsubstantiated assumptions country’s annual medical waste (ie, about unlicensed assistive person- 480,000 tons) is labeled infectious. nel obscure the challenge of deliv- At the 1990 incineration rate of 50 ering quality patient care.” I think cents per pound for infectious the public should be informed that waste, the annual cost to the US health care system was unlicensed assistive personnel are taking over for RNs and technolo- $480,000,000.2Medical waste, therefore, cannot be considered gists in the OR. Then the public insignificant-in dollars or envican decide if it wants someone ronmental impact. who has been trained for two It is possible to reduce medical weeks or someone who has been waste by choosing reusable prodtrained for two to four years to ucts, Surgical departments, which take care of them. generate 50% of hospital infectious Registered nurses have an waste? are a good place to begin. extensive education in the pathoOne hospital reported achieving physiology of diseases with intersurgical waste weight reductions of ventions and treatments. I believe if the public had a choice of some- 73% and volume reductions of one with an extensive educational 93% by replacing disposableproducts with reusables.4 background over someone with a Our nation’s environmental limited skills course, the answer problems are not new; they reprewould be obvious. As for cutting costs, hospital administrators have sent an accumulation of misuse, mismanagement,and mistakes that experts who can delineate other are not going to disappear. wasteful hospital expenses that can be cut so that skilled, educated Today’s concerns are accompanied by a clear and distinct mespersonnel can be retained to offer sage-we simply can no longer appropriate patient care. LOREllA M. RAVEN afford the luxury of using someRN, BSN thing once and then throwing it STUDENT away. COLLEGE MISERICORDIA NATHAN 1. BELKIN PHD D a m , PA CLEARWATER, Fu REDUCE REUSE, RECYCLE TALC POUDRAGE n their July article “Estimating the true costs of disposfound the July article “Talc poudrage for treatment of able and reusable instruments,” the authors comment that pleural effusion in selected hospitals generate only 2% of the patients” by Isabelita C. Tampinco-Golos, FW,BSN, timely, and it total municipal waste and that answered many questions I had disposable surgical drapes and gowns represent less than 2%of about the procedure. I was impressed with the author’s insight hospital waste. They logically and knowledge-right up to the conclude, therefore, that “2% of paragraph on talc sterilization. 2%is insignificant compared to Talc sterilization has been a hot total municipal waste.” This statement does not appear to sup- issue for several years because talc
T
I
I
333 AORN JOURNAL
cannot be sterilized by ethylene oxide (EO) or by steam. Talc repels water, a fact that was not directly referenced by the author. An EO sterilization process depends on the moisture in the cycle. Please correct this misinformation or publish some scientific evidence that confms that what we have assumed all these years about talc and EO is incorrect. If EO penetrates talc, many people will be thrilled-and the company advertising an expensive dry-heat oven for sterilizing talc will be acutely disappointed. CAROL BALL RN, BSN, CNOR, CSPDT, RCST CENTRAL PROCESSINdLINEN DIRECTOR, THEVALLEY HOSPITAL RIDOEWOOO, NJ
Clinical editor‘s response. My research concludes that you are correct (ie, there are no known data to support talc sterilization using EO). We cannot, therefore, conclude that EO is an effective or desirable method for sterilizing talc. A dry-heat sterilization method is the only method that has been validated as an effective sterilant for p o ~ d e rOne . ~ company has performed an internal study that demonstrates the effectiveness of using a fully jacketed sterilizer (ie, with steam to the jacket only) to sterilize the powder. The sterilizer walls emit heat to stimulate the dry-heat method of sterilization.6 The author of the article about talc poudrage treatment did not have this information at the time her article was published. In addition, the author’s institution contracted with an industry source to sterilize the powder used in talc poudrage procedures. We were unable to obtain information from this industry source to verify the effectiveness of