Reusable LMAs
this is an Ambu Aura40 reusable LMA used at st Joseph’s health centre in Toronto, and is Not intended to endorse one brand over another
Opportunity
Opportunities to introduce reusable supplies should be sought whenever possible. The overarching principle to provide climate-smart care must prevail. Canada is a signatory to WHO’s #COP26 Health Programme and is committed to providing climate-resilient and low-carbon sustainable health systems.
Benefits
Benefits include the reduction of waste and carbon emissions, preservation of resources as well as reduced cost. This is all done without compromising patient safety.
Solution
Converting to reusable vs single-use is currently the more sustainable choice and this is supported in the literature with two life-cycle analyses specific to LMAs. LCAs are the most robust form of evidence we have. There are other LCAs comparing other types of reusable vs disposable items such as surgical linens that also arrive at similar conclusions. In the same vein, anesthesia machine reusable breathing circuits and masks would be something to look at as well for their environmental and cost-benefit.
Process
Any such initiative requires planning, stakeholder involvement, education and once rolled out, constant vigilance to ensure compliance with the necessary protocols of collection and cleaning.
We had buy-in from our anesthesia dept., OR admin, MDRD, OR inventory staff, nursing and our cleaning and nursing aid staff. All parties were aware and informed.
Having signage and posters in each OR would be highly advisable reminding everyone NOT to dispose of reusable LMAs.
Anticipated Challenges
The most common barrier before implementation is to get this buy-in. The evidence supports the practice as more sustainable. There is an initial cost outlay. There is practice change and workflow change for many. There are new processes that will need to be followed in MDRD. There are many pieces that need to come into place to get this going but that should not ever be a hindrance to implementation.
The biggest barrier to ongoing success if you will is the inadvertent disposal of a reusable LMA because of a lack of awareness/knowledge of new staff or trainees flowing through. It can take just one person who is not aware to start to throw LMAs away and the next thing you know you are down many LMAs very quickly. Anecdotally, we have heard this was the sole reason many places that have previously tried going to reusable LMAs stopped and went back to disposable (as they kept losing inventory). It is important to have a method to stop that from happening and it is paramount to ensure the onboarding of all new staff/trainees. We have a one-page primer for all new staff and trainees in our department. Similarly, those responsible for collecting used LMAs need to have ongoing education for new hires as well as reminders, refreshers and feedback for current staff.
Resources
Contacts
Contributed by Dr. Ali Abbass