Reuse in Australia?

I just had one more question! (Well, for now anyway) I was wondering if reuse of the dialyzer was a practice in Australia?

That is an easy one.

Australia legislated to prohibit reuse of medical equipment - including haemodialysers - in the early 90’s … I can’t remeber the year but I think it was in 1993-ish.

Re-use thus has been prohibited for 2 decades now.

I’m fighting the urge to once again seek asylum in your country, actually I did run the idea of asylum in Canada by some Canadians I was training on a machine at work - but I finally decided to stay here and duke it out.

Anyway, over the years I have seen why, just maybe, your country decided to ban reuse. Here is one fairly recent reason:

(picked this up from the dialysis advocates site:

"Among reports comparing the use of formaldehyde as the reuse germicide with single-use practices, one study revealed a 12% decreased mortality risk in the reuse group (11). The six other studies did not demonstrate significant differences in mortality between the two practices (12,15,17–20).

Among studies that compared the use of glutaraldehyde as the reuse germicide with single-use practices, only one study revealed a 13% increased mortality risk in the reuse group (17). Five other reports did not demonstrate significant differences in mortality between the two practices (12,15,18–20).

Similarly, among studies that compared the use of peracetic acid as the reuse germicide with single-use dialyzer practices, two studies revealed an increase in mortality by 10 to 17% (12,17). One study of longer follow-up duration revealed a 15% higher death risk in the reuse group in the first 2 years of this practice, which abated in the subsequent 3-year follow-up period (18). Three other studies did not reveal any mortality difference between the two groups (15,19,20).

Four studies grouped a combination of reuse methods and compared this practice with dialyzer single use (10,13,18,21). Only two studies demonstrated a 5 to 25% increased mortality risk in the reuse group (13,21)."

“The risk for hospitalizations between single-use and reuse practices was assessed in three studies (13,14,20). When formaldehyde was used, one study documented no difference (14), whereas the other two documented a 29 to 75% increase in hospitalization rates in the reuse groups (13,20). With glutaraldehyde, two studies reported no difference in the rate of hospitalizations (13,14). When peracetic acid was used, three studies documented an 11 to 28% increase in hospitalization rate in reuse groups (13,14,20).”

And what others have had to say about reuse:

Reuse (part A):

Reuse (part B):

I’ve gone back and forth about this issue with people from davita. I’ve shown them some of the above and they have shown me their studies from what I consider good company people (I’m being nice).

But one thing they haven’t been able to deny is their inability to take out human error after all these years of doing reuse:

Betty Allen:

That’s a very sad story, Plugger. :frowning: I wasn’t aware that deaths resulting from errors in dialyzer reuse didn’t have to be reported. My understanding is that Fresenius stopped reusing dialyzers some years back–both because it was cheaper for them to use the ones they made themselves than to pay staff to do the reuse, and because it it is hard to prevent reuse errors.

John, is there any way to make NOT reusing dialyzers more eco-friendly? Clearly, there is an environmental impact to single use dialyzers. (But also to the chemicals to reuse them…) Which practice is greener?

I considered it a big step forward when Fresenius stopped doing reuse.

Dori … before answering your question, I should make the point that I am an avid believer in single use only of medical equipment … or at least that is my view prior to the release of the Baxter High Dose Home HD machine (see a synposis at my website in the new technology section). It may change my mind on this, as did the Aksys system during its brief but glorious time on earth.

Now to your question … is there any way to make NOT reusing dialyzers more eco-friendly? Clearly, there is an environmental impact to single use dialyzers … but also to the chemicals [that enable] reuse … Which practice is greener?

While both re-use and non-re-use have significant environmental concerns, I don’t think I am able to quantify them sufficiently - one against the other - to claim one is greater than the other … I can say that it is certainly a ‘piece of environmental work’ that is crying out to be done in a systematic way by a researcher somewhere. Sadly, few other than ourselves and the Brits have made any attempt at ‘green dialysis research’ … and even the work that we and the UK teams from Green Nephrology UK remains rather rudimentary and elementary.

I have documented some of our work and some of the simple steps that can be taken and that we have taken to reduce the environmental impact at the new website we are building here from my unit in Geelong: though I am rather embarrassed that the website remains very naive and simple at the moment. I have a little money from our own donations fund that I am putting to it to ‘tart it up’ and make it a little more ‘professional’ … my IT skills are poor, at best … but I hope some of your readers check it out, meanwhile forgiving its inadequacies until it goes live in its more professional format in the next week or two. If they read it through, they will see the breadth of impact a green dialysis program might have - and the extent of the work that needs to be done in this area.

That said, re-use creates a number of environmental issues of important impact.

Reuse … beyond dangers to the patient; incomplete peracetic acid wash-out, or the risk of inter-patient dialyser swap-overs, among others: and dangers for the staff; exposure to fumes and sterilizing agents, and the risk of agent ‘spray’ from poorly connected dialysers or pressure-burst seals - there are a wealth of other technical or practical risks as well … invokes a number of potential ‘green’ issues. Chief among these are the exposure of the environment (all of air, soil and water) to the peracetic acid or the other ‘sterilizing’ products that are used for dialyser cleaning and sterlizing of blood products. These have to ‘go’ somewhere - either in gaseous or liquid form - and if they are good enough agents to purify dialyser fibres of blood products and/or viral and bacterial contamination etc., they are bad enough to be environmental toxins of some magnitude. We like to think we handle them responsibly - but, often that is not as well-done as it might be and, even if well done, our disposal techniques are far from fool-proof. And, at the end of the reuse process, there is still a dialyser + lines (these are usually NOT re-used but are discarded after every treatment) to dispose of.

On the other side of the coin is the environmental hazard of a far larger number of single-use dialysers + lines, all still blood-contaminated and all potentially infectious that are then commonly either buried as infectious waste in land-fill or incinerated (sniff the air!) with the toxic wastes/fumes etc that this process generates.

Which is better or worse?

Someone … anyone … PLEASE … do the work needed to know. How nice it would be to interest someone … anyone … in some of this stuff to start the environmental ball rolling.

I have tried, in my own small way, through our program here in Geelong to reuse and recycle water - and the literature we have generated to alert to these potentials = the 1st of its kind, I believe, anywhere … see our bibliography at the site. I have tried to alert, also, to the potentials for solar-assisted dialysis through the program we have developed here in facility-based and home-based power augmentation through alternate power options (ditto in the bibliography at the site. I pleaded in HDI last year for more interest and activity in waste management practices in dialysis services in my paper 'Personal Viewpoint; HDI Hemodialysis International. 16 (1); 6-10. January 2012.

It is only when others, far wiser and more effective as researchers than am I, take up these challenges that progress will be made and the questions that you ask, Dori, will find answers.

The Brits are doing it now - bless them! I only wish others would join the list.

How about it, America?