I applaud Dr. Tewfik and Mr. Paschall for their recent ASA Monitor article “Supply Chain Concerns and the Effect on Health Care Systems: Essential Considerations for Anesthesia Providers” (ASA Monitor 2022;86:1-8). However, noticeably absent from their “Strategies to mitigate supply chain vulnerabilities” was any mention of switching to reusable products when they are available and safe.
Those of us who trained in the 1980s remember that most of our anesthesia equipment was reusable, and it worked just fine. Yes, it does require cleaning, but at least you have the device when you need it, irrespective of the supply chain issue of the day. The idea that everything needs to be thrown away after one use is a relatively recent concept. The switch to disposables was not just a matter of convenience for the user or perceived safety for the patient; single-use disposables are far more profitable for the manufacturer. You can guess where some of the push for disposables has come from.
Disposable products require the supply chain to reliably deliver vital products every single day. If the supply chain involves China, “reliability” is currently impossible. The supply chain for nearly all disposables involves China for at least some component. China has experienced COVID lockdowns and shutdowns, worker unrest, shipping container shortages, shipping unloading delays as well as tariff disputes, and geopolitical posturing with their neighbors and the United States. Many geopolitical experts are predicting that China’s problems will get worse before they get better, and may never get back to what we think of as “normal.”
Obviously, many sterile products such as medications, catheters, and I.V. tubing, to name a few, cannot be reused. However, nonsterile products such as forced-air warming blankets can easily be substituted with readily available reusable, conductive warming blankets and mattresses. Aside from their other advantages, such as being more effective and cheaper, these reusable warming products are not experiencing supply chain challenges.
Over the course of 12 months, an average OR doing 2.6 cases/day would expect to use approximately 676 forced-air blankets or heated gowns, or both. Depending on the mix of blankets or gowns, that will require around 200-440 pounds of plastic that is most likely made in China. With the U.S. forced-air warming market consuming tens of millions of pounds of plastic annually, it is certainly not a surprise that there may be material shortages and “supply chain issues.”
It’s also worth mentioning that the 676 forced-air blankets or gowns used in that one OR become 200-440 pounds of nonrecyclable waste plastic each year (asamonitor.pub/3lFjttr). The production and incineration of that plastic results in 1,200-2,640 pounds of CO2 (asamonitor.pub/3KdJ5Ia).
Perhaps it is time to reconsider our obsession with throwing everything away after a single use.