背景:美国医疗保健部门是最大的污染行业之一,对人体健康有重大不利影响。医疗设备后处理(MDR)是一种可持续性解决方案,有可能减少医院浪费。减少碳排放,减少支出,并提高供应链的弹性;然而,只有一小部分FDA批准的设备实际上被重新处理。因此,我们进行了一项定性研究,以了解扩大MDR的障碍和促进因素。
结果:我们在新英格兰的大型学术卫生系统和国家MDR组织中对17个利益相关者(超过主题饱和度)进行了深入访谈。我们还通过卫生系统的实地考察收集了观察结果。我们从2021年6月到2022年4月通过目的性抽样招募了参与者。使用以实施研究综合框架为指导的分析方法,我们应用了与关键实现结构相关的归纳和演绎代码。然后,我们进行了主题分析,并确定了与MDR的障碍和促进者有关的五个总体主题。首先,受访者解释说,监管机构和原始设备制造商确定哪些设备可以再处理。例如,一些受访者表示,原始设备制造商使用强制过时的策略,以防止其设备被重新处理。第二,受访者解释说,MDR与医院优先事项具有可变的兼容性;例如,MDR的潜在成本节约与他们的优先事项是一致的,而对再加工医疗设备功能下降的看法是不相容的。第三,受访者表示,医生的偏好会影响重新处理设备的订购。第四,受访者解释说,员工对MDR的不同知识和信念会影响他们选择和收集可再处理设备的动机。最后,受访者强调,在其卫生系统中缺乏评估和维护MDR计划的基础设施。
结论:根据我们的发现,我们概述了一些针对这些障碍和促进因素的建议,以便在该卫生系统和全国范围内实现MDR的环境和财务利益.例如,实施防止原始设备制造商使用强制淘汰策略的联邦政策可以促进在全国范围内扩大MDR。此外,提供生命周期评估,比较一次性使用的环境影响,可再处理的一次性,和可重复使用的设备可以促进卫生系统的采购决策。创建并向医院工作人员传播审核和反馈报告也可能有助于他们继续参与该计划。最后,雇佣一名全职计划经理来领导卫生系统内的MDR计划,可以提高计划的可持续性。
The United States health care sector is one of the largest polluting industries, which has significant adverse effects on human health. Medical device reprocessing (MDR) is a sustainability solution that has the potential to decrease hospital waste, cut carbon emissions, reduce spending, and improve supply chain resiliency; however, only a small proportion of FDA-approved devices are actually reprocessed. Thus, we conducted a qualitative
study to understand barriers and facilitators of scaling up MDR.
We conducted in-depth interviews with 17 stakeholders (exceeding thematic saturation) at a large academic health system in New England and national MDR organizations. We also collected observations through site visits at the health system. We recruited participants from June 2021 to April 2022 through purposive sampling. Using an analytic approach guided by the Consolidated Framework for Implementation Research, we applied inductive and deductive codes related to key implementation constructs. We then conducted a thematic analysis and identified five overarching themes related to barriers and facilitators of MDR. First, respondents explained that regulatory bodies and original equipment manufacturers determine which devices can be reprocessed. For example, some respondents described that original equipment manufacturers use tactics of forced obsolescence that prevent their devices from being reprocessed. Second, respondents explained that MDR has variable compatibility with hospital priorities; for example, the potential cost savings of MDR is compatible with their priorities, while the perception of decreased functionality of reprocessed medical devices is incompatible. Third, respondents described that physician preferences influence which reprocessed devices get ordered. Fourth, respondents explained that variable staff knowledge and beliefs about MDR influence their motivations to select and collect reprocessable devices. Lastly, respondents emphasized that there was a lack of infrastructure for evaluating and maintaining MDR programs within their health system.
Based on our findings, we have outlined a number of recommendations that target these barriers and facilitators so that the environmental and financial benefits of MDR can be realized at this health system and nationally. For example, implementing federal policies that prevent original equipment manufacturers from using tactics of forced obsolescence can facilitate the scale-up of MDR nationally. Additionally, providing life cycle assessments that compare the environmental effects of single-use disposable, reprocessable disposable, and reusable devices could facilitate health systems\' purchasing decisions. Creating and disseminating audit and feedback reports to hospital staff might also facilitate their continued engagement in the program. Lastly, hiring a full-time program manager that leads MDR programs within health systems could improve program sustainability.