CHAPTER 1

HOW THE CONFERENCE CAME TO BE

Wakening concern for problems related to the use and disposal of ingle-use items in health care facilities was first noted in the early 960's. Those who exhibited interest at that time were too few to draw harp attention to a growing need for action. Subsequently, as the eneral use of single-use items increased, improved technology volved for the development and production of disposables together with new packaging techniques. Improved materials, especially plascs, contributed greatly to this growth. Such factors, accompanied by stitutional labor shortages and rising labor costs, focused attention n the utility of single-use items.

The growing use of special medical items drew the attention of onsumer institutions and regulatory agencies in 1965-1966. The merican Public Health Association acted at that time to establish a pecial ad-hoc committee to deal with the singular problem of singlese syringes and needles. While the committee focused its attention on is specific issue, it fully recognized the emerging problem and its pidly broadening nature.

Early in 1967, a group of manufacturers from the pharmaceutical d packaging fields informally contacted the National Sanitation Fountion to express interest in a voluntary program to identify the magude of the problem and determine appropriate action. Their lection of NSF to explore the issue was based upon the Foundation's perience and success in dealing with other emerging problems of the vironment. They thus related the Foundation methodology to study of oblems related to single-use items. Further meetings and discusns in the late spring of 1967 established the basis for the National ference on the Use and Disposal of Single-Use Items in Health Care cilities.

It was mutually agreed that the Foundation would undertake, in laboration with representative members of industry and governit, a preliminary identification of the scope, purpose, and objectives such a conference as well as measures necessary for financing it. lowing extensive discussions the Foundation secured financial comment on an equal partnership basis between industry and the artment of Health, Education, and Welfare (Division of Hospitals Medical Facilities, and the Solid Waste Program).

With funding assured, the National Conference was scheduled for 1968 in Ann Arbor, Michigan. Attendance was planned for not more one hundred persons with the primary objective of defining probs and eliciting ideas for appropriate solutions. The conference

CHAPTER 2

ACKNOWLEDGMENTS

The conference on single-use items herein reported was a result the ideas and efforts of many people. Appreciation is expressed to 11 who gave of time, talent, and resources in carrying out the venture. pecial mention is made of the following contributions without which it would not have been possible to conduct the conference.

The concept of such a meeting was first advanced by leaders of ndustries manufacturing disposables, containers, and packaging maerials. It was through efforts made by them that representatives of a arger industry group assembled to explore the nature of the problem nd to see what might be undertaken to solve it. Subsequently the representatives of the several manufacturers agreed to give financial support on a matching basis to the conducting of a national conference provided that official regulatory agencies would do likewise.

Early in the exploratory discussions representatives of the hospital construction programs of the United States Public Health Service joined to share knowledge and effort in addressing the problem. Sometime later participation was added by representatives of the solid wastes program of USPHS. These persons felt it to be an appropriate responsibility of their programs to assist in conducting a working conference and funding it as proposed by industry.

With the subsequent appointment of a conference planning and organizing group, additional persons became involved. Through this process the names of those to be invited to participate were identified. Others were appointed to serve as conference speakers, work group leaders, and reporters. And of ultimate importance to the total venture was the enthusiastic interest and involvement of the conference participants.

To all of these persons, individually and collectively, NSF expresses sincere appreciation-on its own behalf for help generously given in organizing a successful conference; and for the effective contribution made by all toward the definition and ultimate solution of the disposables problem.

CHAPTER 3

PLANNING, ORGANIZATION, AND OPERATION

The idea of the National Conference originated with leaders of the industry manufacturing single-use items, containers, and packaging materials. A preliminary contact with NSF served to confirm a mutual interest in addressing the problems of disposal associated with these products. Subsequently the small industry group initiated a further round of contact within industry to determine the willingness of management representatives to meet and seek agreement as to the nature and extent of the disposables problem and its effects upon the consumers of their products.

After decision was made to hold the conference and arrangements for funding it were confirmed, a steering committee was formed to plan for arrangements and organization. The committee decided that the basic purpose of the conference would be to seek definition and solution of problems associated with use and disposal of single-use items in hospitals, laboratories, professional offices, nursing homes, and similar health care facilities. The range of conference considerations would not be limited, with the ultimate objective of disseminating information developed to all parties concerned.

The steering committee met on two occasions during the fall of 1968. Dates for the Conference were set for December 4 and 5, 1968. It was decided that both program and format for the meeting would be developed along identical lines. There would be multi-interest presentation of problems and issues; and deliberation of the participants would be brought to bear in a similar way. Presentation and consideration of material would feature: supply aspects (manufacturers/suppliers); operation aspects (institutional and professional); and disposal aspects (institutional and community).

Decision was made to have participation by personal invitation in order to achieve appropriate representation and mix of the multiinterests. From lists of persons known to be knowledgeable and competent in the field (as supplied by members of the steering committee) approximately two hundred invitations were extended. Information was also supplied as to the interest and work background of the persons invited. Thereby they were categorized as representing the concerns of: manufacturers/suppliers; community agencies and services; care institution services and operations; professionals in practice, consultation, or teaching; and representatives of professional associations. From the final tally of persons accepting invitation, a "pool" was made of persons representing the five areas of concern just noted. Names were drawn at random from each pool to assign members to the three discussionals on supply, operation, and disposal. Thus there was

provided an equal multi-interest mix of the several areas of concern in each of the discussionals.

(Although question was raised by several participants as to whether they had been assigned to the wrong discussional, all were asked to participate as grouped unless anyone felt seriously disadvantaged. Many comments were later received that the multiinterest approach to issues had been personally beneficial and collectively productive.)

The Conference itself was divided into four sessions: an opening plenary meeting at which basic issues were placed for consideration before the conferees in formal papers; two working sessions of the three discussionals (afternoon of the first day and morning of the second); and a concluding plenary meeting at which the reports of the hree discussionals were presented by the recorders. The formal papers and the discussional reports are presented verbatim in Chapter

.

As background information for Conference participants, the ollowing services were provided:

A compilation was made of the commonly available singleuse items in hospitals. Through assistance of several suppliers and local hospitals, a large number of such items were secured for display purposes. Three large exhibit panels were used to demonstrate items used in patient care, food service, and medical-surgical procedures.

Reprints of two pertinent articles were sent to all participants prior to the Conference:

"Solid Wastes Handling," by Ralph J. Black, published by the Solid Wastes Program of the United States Public Health Service; "Disposable Hospital Supplies, Some Administrative and Technical Implications," by George S. Michaelsen and Donald Vesley, published in Hospital Management, January 1966.

The Foundation made inquiry of the fifty states to determine the nature and scope of any state regulations dealing with singleuse items in health care facilities. (A summary of this survey is included in the appendix of this report.)

In order to assist discussional leaders in activating discussion, a series of topical questions was prepared for each of the groups. No effort was made to press attention to these questions nor to develop answers. In several instances they served usefully as discussion guidelines.

The Conference was operated in conformance with the plan and anization described. Participation by members of the group was ly and interested. There was a general expression of gratification the occasion offered by the Conference to give needed attention to disposables problem. Copies of this report will be sent to a large

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