The cost of being clean: A cost analysis of nasopharyngoscope reprocessing techniques

Abstract

Objective Nasopharyngoscopes are an essential instrument to otolaryngologists; reprocessing them in a high‐value manner is paramount. Although several different techniques for reprocessing exist, all methods yield similar effectiveness. Given equivalent effectiveness outcomes, a cost analysis of four nasopharyngoscope reprocessing techniques was performed. Study Design Cost‐minimization analysis. Methods Four techniques were evaluated: 1) an automated reprocessor using peracetic acid (Steris System 1; Steris Canada Inc., Mississauga, Canada), 2) an automated reprocessor using ortho‐phthalaldehyde (OPA) (Cidex OPA; Advanced Sterilization Products, Johnson and Johnson Inc., Markham, Canada), 3) a manually performed accelerated hydrogen peroxide bath (Revital‐Ox; Steris Canada Inc.), and 4) a chlorine dioxide wipe (Tristel Trio Wipes System; Tristel plc, Cambridgeshire, U.K.). The costing perspective was a third‐party payer that was adjusted to 2014 Canadian dollars. The base‐case scenario used an annual volume of 4,153 reprocessing events in a tertiary care setting, and a scenario analysis assessed the impact of volume and capital expense. Results The cost per reprocessing event for the Steris (Steris Canada Inc.) automated endoscope reprocessing, Cidex OPA (Advanced Sterilization Products), Revital‐Ox (Steris Canada Inc.), and Tristel Trio Wipes (Tristel plc) were $20.58, $14.20, $9.57, and $13.14, respectively. Scenario analysis demonstrated the Tristel Trio Wipes System (Tristel plc) was the least expensive method in practices with low reprocessing volumes (a threshold of less than 6 events per day, or 22 per week), whereas the Revital‐Ox (Steris Canada Inc.) system was least expensive at higher volumes and became substantially more so as volumes increased. Conclusion A manual accelerated hydrogen peroxide bath offers the least costly approach to nasopharyngoscope reprocessing. The convenience and portability of the Tristel Trio (Tristel plc) system may be a good alternative for low reprocessing volumes, or when rapid turnaround is necessary. Level of Evidence NA. Laryngoscope, 128:64–71, 2018

Disposable chlorine dioxide wipes for high-level disinfection in the ENT department: A systematic review

“…Cost-analyses are summarized in Table 4 [9,13,15,16]. Costs are reported in local currency at the date of original publication and in American dollars, converted on 10th July 2019, not accounting for price and currency fluctuations over time.…”

“…Among the features justifying the great diffusion of TTWS, cost-effectiveness plays a major role. The available cost-analyses conclude that in low-and medium-volume centers TTWS appears to be more economical than AER or sheaths [9,13,15,16]. Although the cost-minimization analysis performed by Sowerby et al was conducted in North America, the authors state that the system has not yet received FDA approval, probably due to a need for greater recognition of the difference between NPs and other flexible endoscopes, such as those used for gastrointestinal and bronchial tracts [16].…”

The Cost Effectiveness of Single-Patient-Use Electrocardiograph Cable and Lead Systems in Monitoring for Coronary Artery Bypass Graft Surgery

“…Real-world implications of this are demonstrated by the fact that removal of one of these devices was linked with the containment and end of an outbreak of Pseudomonas aeruginosa (32). Full and proper disinfection and reprocessing of reusable medical devices comes at cost (35), which is one item not considered in our analysis. Including these costs would, however, only increase the cost effectiveness of spECG, and so our results likely provide a conservative estimate of benefit.…”

Reprocessing semicritical items: Outbreaks and current issues

“…Based on the infection data and risks, the transition to sterilization of duodenoscopes was recommended by an FDA Panel in May 2015. Technologies to allow this change to occur are being developed 68 and FDA-cleared and should be used when acceptable in terms of sterilization performance, scope performance (for disposable scopes), cost, throughput, and compatibility of materials (eg, adhesives) to sterilization technology. Device and sterilization manufacturers, regulatory agencies, GI physicians, inpatient and outpatient endoscope reprocessing centers as well as professional organizations must reach a general agreement regarding the need for sterilization and the willingness to replace existing disinfection technologies.…”