Intersurgical's Multipac Breathing System allows reuse of anesthesia breathing circuits (BC) resulting in cost savings and reduced medical waste.

Authors: R Daggan, CRNA, MS, D.Steinberg, M.D., G.Larijani, PharmD.I Gratz, D.O., A Zafeiridis phD, ME Goldberg, MD.

Affiliation: The Cooper Heath System/UMDNJ, Department of Aneesthesiology, Robert Wood Johnson Medical School at Camden, NJ

Introduction: Previously we demonstrated that (BC) can be recycled resulting in cost and environmental savings1. In the past practitioners have reused washed anesthesia circuits, but with the rise of universal precautions this practice has disappeared. With the development of specific viral and bacterial filters the possibility of newer circuits being reused needs to be investigated. The purpose of this study was to determine if Intersurgical’s Filta-Therm® filter between the patient and the (BC) prevents contamination and allows the reuse of Intersurgical’s Multipac circuit with considerable cost savings.

Method: After obtaining IRB approval, FDA reviewed filters and reusable (BC) were used to study 52 patients. Prior to anesthesia, cultures were obtained from (BC) at the Y-piece distal to the filter (using patient as reference point), and at the inspiratory and expiratory ports proximal to the anesthesia machine. Immediately after anesthesia, cultures were obtained from the proximal end of the endotracheal tube at the Murphy eye, and the Y-piece distal to the filter. The cultures were incubated and the results examined at 24 and 48 hours. The cost of red bag waste and the number of (BC) used in the operating room annually were calculated. We assumed that in contaminated cases (respiratory tract infection, frank blood and secretions within the circuit) we would not reutilize the circuit. The cost of our current practice of disposing (BC) after each use was compared with the cost after reusing the (BC).

 Results: All 52 cultures obtained at the endotracheal tube site (patient side of the filter) grew various organisms such as Candida albicans, Alpha Streptococcus, Neisseria species, Staph Species, Proteus species, Non-hemolytic Strep, Corynebacterium, Gram negative rods, Klebsiella, and Pseudomonas. Prior to anesthesia cultures of Y-piece, and the inspired and expired ports showed no growth after 48 hrs. However, two circuits demonstrated growths in the expiratory port (streptococcus, neisseria and enterobacter) as a result of culture contamination. Following anesthesia all 52 Y-piece cultures (machine side of filter) showed negative growths after 48 hrs of incubation.

Discussion:
We demonstrated that the use of circuits with appropriate filters does not result in bacterial contamination. Since filter size is 0.017µm, known viral particles are not expected to penetrate the filter. We use 55 (BC) daily.

Assuming reuse of 36 (BC), 250 operation days, and weight of 1 lb/ (BC), the savings from waste disposal are $2,727/ yr (36 BC x 250 days x $0.303/ BC). Moreover, with the cost of our current (BC) AT $13.16, the savings associated with the reusable circuits (36/ day), are $108,452/ yr. The cost of reusable (BC) includes $5.75/ (BC) and $5.00/ case for new filter, elbow, and mask. The total savings for waste disposal and (BC) are $111,179/ yr. We conclude that reuse of (BC) results in considerable cost savings without risks of viral and bacterial transmission.

References:
1. Jml of Clin Anes 1996; 8:475-479
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