Disposable Equipment Research Articles

Pharmaceutical and Supply Waste in Oculofacial Plastic Surgery at a Hospital-Based Outpatient Surgery Center.

To investigate the financial and environmental waste burden of unused disposable surgical supplies and pharmaceutical products in oculofacial plastic surgery at a hospital-based outpatient surgery center. This descriptive study was performed at a single academic hospital-based outpatient surgery center. Unused pharmaceuticals and disposable surgical materials were recorded for each of 34 consecutive oculofacial plastic surgeries performed by the same surgical team. Pharmaceutical products were grouped as local anesthetic (tetracaine, bupivacaine, lidocaine, and sodium bicarbonate), intraoperative (basic saline solution, methylene blue, and oxymetazoline hydrochloride), or antiseptic/antimicrobial (erythromycin ointment and hydrogen peroxide). Percentage of unused pharmaceutical product and disposable surgical material were calculated and extrapolated to direct costs to the institution and greenhouse gas emissions. The mean percentage of disposable surgical supply waste per case was 11.6% ($29.32). The mean percentage of pharmaceutical waste was 96.1% ($271.84) for local anesthetic, 71.0% ($163.47) for intraoperative medications, and 26.7% ($2.19) for antiseptic medication. The mean emissions per surgical case for unused disposable surgical equipment and unused pharmaceutical product were 10 and 103 kg of carbon equivalent gases (kg CO2-e), respectively. Surgical supply waste was nominal, but pharmaceutical waste was considerable in this single hospital-based outpatient surgery center study. There may exist opportunities for quality improvement in waste, especially pharmacologic burden, in oculofacial plastic surgery.

Comparison of the Costs of Reusable Versus Disposable Equipment for Endoscopic Carpal Tunnel Release Procedures Using Activity-Based Costing Analysis

Guidelines for sterilization of reusable equipment (eg, arthroscopes, surgical equipment) have recently been established. These guidelines are supported by the U.S. Food and Drug Administration and affect costs for sterilization. The current analysis was undertaken to understand if reusable or disposable endoscopic carpal tunnel release (ECTR) equipment is a less-expensive option. An activity-based cost analysis was undertaken to determine the costs of reusable versus disposable equipment for ECTR. Costs of disposable equipment were obtained from manufacturers. Costs of processing reusable equipment including labor, time, cost of operating room time, and sterilization supplies and equipment were obtained from the literature and from recent reports identifying these costs. Infection rates and costs of infection were also factored in. Decision analysis software was used to determine the expected costs of each option (disposable vs reusable). A sensitivity analysis was undertaken on those variables that were determined to have the greatest effect on the overall costs of the procedure and sterilization. Costs for each option when totaled were $917 for disposable and $1,019 for reusable equipment, resulting in cost savings of $102 with disposable equipment. Reusable equipment was the least costly option when the following costs/events occurred: cost of a disposable arthroscope, >$452; cost of disposable ECTR, >$647; costs of operating room time, <$28.63/min; set up time, <6.8 minutes for reusable equipment; and cost of disposable ECTR blade used with reusable equipment, <$160. When considering the cost of operating room time, preparation, and processing of reusable equipment for ECTR, the disposable equipment for this procedure is less costly. Economic Analysis II.

Percutaneous transhepatic biliary drainage (PTBD) in patients with dilated vs. nondilated bile ducts: technical considerations and complications

ObjectivesThe aim of this study was to compare success, technical complexity, and complication rates of percutaneous transhepatic biliary drainage (PTBD) in patients with dilated vs. nondilated bile ducts.MethodsIn a retrospective analysis, we evaluated all consecutive PTBD performed in our department over a period of 5 years. Technical success, technical data (side, fluoroscopy time, radiation dose, amount of contrast media, use of disposable equipment), procedure-related complications and peri-interventional mortality were compared for patients with dilated vs. non-dilated bile ducts. Independent t test and χ2 test were used to evaluate the statistical significance.ResultsA total of 253 procedures were performed on 187 patients, of whom 101/253 had dilated bile ducts and 152/253 not. In total, 243/253 procedures were successful. PTBD was significantly more often successful in patients with dilated vs. nondilated bile ducts (150/153 vs. 93/101; p 0.02). Overall complication rate (13%) did not differ significantly between patients with dilated vs. nondilated bile ducts. Procedures in patients with normal, nondilated bile ducts were associated with a significantly higher rate of post-interventional bleeding (5/101 vs. 0/152). Mean fluoroscopy time (42:36 ± 35:39 h vs. 30:28 ± 25:10 h; p 0.002) and amount of contrast media (66 ± 40 ml vs. 52 ± 24 ml; p 0.07) or use of disposables were significantly higher in patients with nondilated ducts. A significantly lower fluoroscopy time and amount of contrast medium were used in left hepatic PTBD.ConclusionDespite the higher technical complexity, PTBD with nondilated bile ducts was associated with similar overall complication rates but higher bleeding complications compared with PTBD with dilated bile ducts.Key Points• PTBD was associated with similar overall complication rates in patients with dilated vs. nondilated bile ducts.• Although overall complication rates were low, PTBD in patients with nondilated bile ducts was associated with a higher incidence of post-interventional bleeding.• PTBD in patients with nondilated bile ducts is technically more complex.

336 The Pragmatic Use of Industrial Elastomeric Respirators in Health Care Practice during the COVID-19 Viral Pandemic

The COVID-19 pandemic has changed the way that we interact with our patients, specifically in regards to the importance of using personal protective equipment (PPE) during all patient interactions. The abrupt onset of the pandemic has created shortcomings, though, in stocks of disposable equipment prompting the use of alternative, often self-provided, PPE. Some practitioners have started to use reusable elastomeric respirator facemasks in lieu of the disposable N95 variety provided in our emergency department (ED).

FUNCIONÁRIOS DA SAÚDE X COVID-19 E O USO DE MÁSCARAS EM LARGA ESCALA NA PREVENÇÃO DA TRANSMISSÃO E INFECÇÃO DO SARS-COV-2

Introdução: em decorrência da sobrecarga dos serviços de saúde por conta da ampla disseminação da COVID-19, a utilização de equipamentos de proteção individual (EPI) descartáveis pela população tem sido desencorajada por diversos órgãos, de modo a reservá-los aos profissionais de saúde devido à grande exposição no atendimento na linha de frente dos pacientes infectados pelo vírus causador da doença, SARS-CoV-2. A recomendação atual é a preferência pela utilização de EPIs, principalmente as máscaras, produzidas a partir de materiais não profissionais para indivíduos da comunidade. Objetivos: através de buscas automáticas em bases de dados internacionais e pesquisas manuais em diversos órgãos e periódicos ao redor do mundo, buscamos descrever a importância dos EPIs na proteção dos profissionais de saúde contra a contaminação do SARS-CoV-2, assim como determinar a eficácia de materiais não profissionais em barrar a transmissão e infecção pelo vírus em contextos não hospitalares, além de reconhecer a viabilidade do uso em larga escala desse artifício. Conclusão: a escassez de EPIs para os profissionais de saúde fomenta a necessidade de deslocar a já exaurida oferta desses equipamentos para aqueles que mantêm o sistema de saúde em funcionamento, assim como levanta a alternativa das máscaras de pano para a população em geral. Existem evidências, com significâncias estatísticas variáveis, que suportam o uso em larga escala de máscaras pela população, ainda que com eficácia reduzida para agentes transmitidos por aerossóis. A preferência da utilização, baseado nos resultados obtidos, é por materiais descartáveis, constituídos de TNT e com elementos filtrantes ou máscaras N95/PFF2, no entanto, na ausência ou dificuldade de obtenção desses equipamentos, assim como em situações de contingenciamento, pode-se fazer uso de tecidos como algodão, tecidos constituídos por 55% poliéster e 45% algodão, tricoline e outros, porém, com redução importante da eficácia.

Reflections on COVID-19 and the ethical issues for healthcare providers

PurposeHealthcare governance places medical ethics at the forefront of defining and maintaining the quality of care. Examples of serious ethical issues include sexual abuse of patients (Dubois, Walsh, Chibnall et al., 2017), criminal prescription of opioids (Johnson, 2019) and unnecessary surgical procedures (Tayade and Dalvi, 2016) or shortages in service delivery because of little knowledge or experience especially during pandemic outbreaks (Hay-David et al., 2020). In many cases involving medical ethics, patients are identified as the first victims; however, this study aimed to consider clinicians and other healthcare practitioners as other probable victims (Ozeke et al., 2019).Design/methodology/approachThe World Health Organization (WHO) estimates that tens of millions of patients worldwide suffer disabling injuries or death every year due to unsafe medical practices and services. Nearly, one in ten patients is harmed due to preventable causes while receiving health care in well-funded and technologically advanced hospital settings (WHO, 2016). Much less is known about the burden of unsafe care in non-hospital settings, where most healthcare services are delivered (Jha et al., 2013). Furthermore, there is little evidence concerning the burden of unsafe care in developing countries, where the risk of harm to patients is likely to be greater, due to limitations in infrastructure, technologies and human resources (Elmontsri et al., 2018).FindingsWhile these problems are endemic in health care, they are exacerbated in times of health and social crises such as the coronavirus disease of 2019 (COVID-19) pandemic. This pandemic has few precedents, being most closely paralleled with the global influenza pandemic of 1918 (Terry, 2020). Initially compared to the severe acute respiratory syndrome (SARS) outbreak of 2002–2003 (Parrym, 2003), COVID-19 is already proving much more deadly. The WHO’s estimates of the number of SARS cases from the start of the outbreak in 2002, until it was brought under control in July 2003, was 8,437 cumulative cases, with 813 deaths (WHO, 2003). The European Center for disease prevention and Control estimated that as of May 15, 2020, that 4,405,680 cases of COVID-19 have been reported with 302,115 deaths (ECDC, 2020)Research limitations/implicationsThe outbreak of COVID-19 was declared in February 2020 in the Islamic Republic of Iran, and up to March 2020, the cases of morbidity reached 12,729, with 611 deaths (Bedasht, 2020). The current figure at the time of editing (May 16, 2020) is 118,392 cases, with 6,937 deaths (Worldometer, 2020). Acting in cognizance of its ethical responsibility to the citizens of Iran, the Iranian government has taken the following action to attempt to mitigate the deleterious effects of the virus: in each province, one or more hospitals have been evacuated and allocated to patients with pulmonary problems with suspected to COVID-19. Access to intensive care units and specialist equipment is a primary ethical issue that concerns the Iranian healthcare system. The issue is exacerbated by the knowledge that these facilities are not distributed equitably in the country. Therefore, equity is the first ethical concern in this situation.Practical implicationsAll nurses, clinicians, practitioners and specialists have been asked to volunteer their services in hospitals in the most infected areas. This raises ethical concerns about access to personal protective equipment (PPE) such as appropriate masks, gowns, gloves and other equipment to protect healthcare workers from infection. Access to PPE was restricted because of government failure to stockpile the necessary amount of disposable medical equipment. This was related to lack of domestic capacity to produce the equipment and problems accessing it internationally due to political-economic sanctions that were imposed on Iran by the USA and some European countries. Such shortages can quickly lead to a catastrophic situation; current evidence demonstrates that about 40% of healthcare workers are vulnerable to the COVID-19 infection (Behdasht, 2020). However, it should be noted that this is not a problem limited to Iran. As of March 2020, the WHO was already warning about PPE shortages and the dangers this posed for healthcare workers around the world (WHO, 2020).Social implicationsA Disaster Committee was created by the Iranian Ministry of Health to take responsibility for decision-making and daily information sharing to the community. The ethical dilemma that arises in terms of reporting the situation is the conflict between transparently presenting accurate and timely information and the creation of public panic and fear that this may cause in the community.Originality/valueAs a steward for public health, the Ministry of Health was afforded direct responsibility to maintain intra-sector relationships and leadership with other organizations such as political executive organizations, municipalities, military agencies, schools, universities and other public organizations to reach consensus on the best methods of controlling the COVID-19 outbreak. An important ethical issue is found in potential areas of conflict between the therapeutic and preventive roles of the Ministry of Health and those related to public health and the civil administrations.

How to Manage Pediatric Orthopaedic Patients: Strategies to Provide Safer Care During the COVID-19 Outbreak in Wuhan, People's Republic of China.

How to Manage Pediatric Orthopaedic Patients: Strategies to Provide Safer Care During the COVID-19 Outbreak in Wuhan, People's Republic of China.

Home sleep apnea testing in the era of COVID-19: a community perspective.

Citation:Kole A. Home sleep testing in the era of COVID-19: a community perspective. J Clin Sleep Med. 2020;16(9):1633.

A Comparative Carbon Footprint Analysis of Disposable and Reusable Vaginal Specula

(Abstracted from Am J Obstet Gynecol 2020; doi: 10.1016/j.ajog.2020.02.007) In an attempt to save time, as well as reduce costs and transmission of infections, many health care systems in the United States have increased use of disposable medical equipment, which generally decrease costs upfront compared with their reusable alternatives. Use of disposable instruments, however, is associated with increased solid waste production and may increase greenhouse gas emissions, negatively impacting the environment.

Market Surveillance of Filtering Facepiece (FFP)of Respirator Protective Equipment (RPE): Malaysian Perspectives

Filtering Facepieces (FFPs) are commonly use as personal protective equipment (PPE). It is disposable Respiratory Protective Equipment (RPE). Basically it is used for protection against dusts, particles and aerosols. Available in 3 classes FFP1, FFP2 and FFP3. Various Respiratory Protective Equipment (RPE) offered in Malaysia’s market today are not being controlled and monitored by expert bodies and authorities. This has led to various perceptions among the users, especially on the quality and safety and health features of the products offered by different companies. This situation also makes it difficult for users to decide appropriate RPE based on quality and standard compliance. The tendency of consumers to choose RPE is mainly based on the price but not the technical aspect of RPE. Hence, the RPE they purchased not necessary enhance user protection, as there is no guidance available to assist user before they purchase the most appropriate RPE. This study describes market surveillance testing of FFP2 respirator from 30 different brand in Malaysia. The objective is to determine performance requirements required by the Malaysia standard. 3 types of testing were used on this study Filter Penetration, Breathing Resistance and Carbon Dioxide Content. All testing was carried out based on Malaysia Standard; MS 2323:2010 and MS2553:2014.All 30 sample were passed the breathing resistance and carbon dioxide content except 10 brand was failed the filter penetration testing. It is noticed that the user and consumer should aware with their PPE basic requirement.

Barrier System for Airway Management of COVID-19 Patients

To the Editor Airway management of patients with coronavirus disease 2019 (COVID-19) poses significant risk to involved staff because of the aerosolizing nature of airway interventions.1 Aerosolization can occur during face mask and supraglottic airway ventilation, intubation, extubation, and cardiopulmonary resuscitation.2 These activities require increased precautions and containment of viral respiratory particles. It has been demonstrated that a containment system can limit the spray of a significant portion of respiratory particles during a simulated cough or extubation.3,4 We applaud innovation of new protective barrier enclosures to protect the laryngoscopist and the room during airway interventions. When selecting such a barrier device, one should consider the importance of access to the airway, containment of aerosolization, time required to set up the device for patient use, and patient tolerance of the device. One should also be cognizant of the cost and necessary time for production and deployment of the device. Some barrier devices, while superior at containing aerosolization, unfortunately restrict the laryngoscopist’s hand movements and would require abandoning a laryngoscopy attempt to remove the barrier if it proved too cumbersome. In some cases, it is important to allow a second pair of hands to access the patient’s airway to aid in the intubation should it prove difficult (providing lip traction, assisting with the stylet, etc). This may not be possible with some barrier devices. In addition, an ideal device could be set up quickly for patient use and not cause patient agitation, which is particularly important in the pediatric population. We propose an inexpensive clear plastic drape on bag barrier system made from materials that are ubiquitous in the hospital (Figure). The barrier can be easily removed even mid-laryngoscopy attempt. This drape on bag system consists of a 40-gallon drawstring bag covering the head of bed space that can be set up before patient arrival. The patient lies on top of it with the bag underneath head and shoulders. A 90 × 95 cm clear rectangular plastic drape (2 clear drapes can be cut from a single drawstring bag) is taped to the patient’s chest and is flipped over the patient’s head and laryngoscopist’s arms during preoxygenation and intubation. A plastic drape clamp attached to the clear drape weighs it down so it stays between the laryngoscopist’s arms. The ease, speed, and patient experience of having this plastic drape taped to the chest is similar to application of electrocardiogram leads. The total cost of disposable materials for this system is $1.44. There is nothing restricting access to the airway from under the drape, so one could easily assist the laryngoscopist or remove the drape during laryngoscopy if required. After intubation is performed and endotracheal tube secured, the clear plastic drape can be tucked into the drawstring bag, which now contains the contaminated airway space for the duration of the case. The patient could be later extubated under the clear drape, and the drape can then be removed and placed in the drawstring bag along with disposable airway equipment such as the suction catheter and stylet. The drawstring bag is then cinched closed, containing the contaminated drape and head of bed space, and can be disposed. We also recommend sealing used laryngoscopy equipment in a Ziplock Biohazard bag (Thermo Fisher Scientific, Waltham, MA).Figure.: Use of plastic on bag barrier drape system. A, Patient lays on top of drawstring bag at shoulder level; clear drape is taped to chest. B, Flip clear drape over laryngoscopist’s arms during airway intervention. C, Extubate with drape tucked into drawstring bag to contain aerosolization. D, Dispose of clear drape in drawstring bag and cinch drawstring bag to contain contaminated head of bed space.This plastic drape on bag system is being trialed at our hospital in the operating rooms and in the emergency department and intensive care unit. In simulated settings at our institution, it provides an added layer of protection from spray of contaminated viral particles for personnel present at airway procedures. The system contains the most contaminated surface surrounding the patient’s airway and can easily be disposed of to maintain a cleaner hospital environment. We found that the best use of this device is for nonemergent intubation of a tolerant or sedated patient. Sarah Brown, MDFiona Patrao, MBBSShilpa Verma, MBBSAlexa Lean, MDSean Flack, MB ChBDavid Polaner, MDDepartment of Anesthesiology & Pain MedicineUniversity of WashingtonSeattle, Washington[email protected]

Pragmatic recommendations for intubating critically ill patients with suspected COVID-19.

Pragmatic recommendations for intubating critically ill patients with suspected COVID-19.

MP22-09 ANALYSIS OF DISPOSABLE EQUIPMENT UTILIZATION ON THE COST OF URETEROSCOPY

INTRODUCTION AND OBJECTIVE: Ureteroscopy (URS) for the management of kidney and ureteral stones utilizes a variety of disposables which can account for a significant portion of the cost of care. We sought to perform a utilization analysis to determine factors which impact the cost of performing URS. METHODS: In a single-institution, retrospective study, an analysis of disposable utilization was performed on all kidney and ureteral stone cases managed with URS and laser lithotripsy between July 1, 2016 and June 30, 2017. These cases were performed by six different surgeons, two of whom are fellowship trained in endourology. Disposable equipment was broken down into the following categories: baskets, ureteral dilators and balloons, laser fibers, access sheaths, stents, ureteral catheters, wires, and miscellaneous. Miscellaneous items included gloves, drapes, gowns, syringes, foleys, needles, bowls, and other items under $40. Disposable flexible ureteroscopes were excluded from this cost analysis. RESULTS: Among the 269 cases included in the analysis, the average cost of disposables used per case was $976.96. Endourology Society fellowship trained physicians performed 127 (47.2%) of these cases Average cost of disposables per case performed by a fellowship trained urologist was $968.54 compared to $984.48 for non-fellowship trained urologists. Figure 1 displays the breakdown of the disposables contributing to overall costs per case. Figure 2 displays the individual surgeon costs based on technique and training. Surgeon A, with fellowship training, and a preferred technique of dusting was the most cost effective overall with an average savings of $124.02 per case. These savings were realized in the low utilization of baskets and sheaths. Although Surgeon F was similar to Surgeon A in technique, the costs were skewed by expensive laser fiber usage. CONCLUSIONS: Technique and training can impact utilization of disposables determining the costs of ureteroscopy.Source of Funding: None

Expert consensus on nursing management for patients undergoing primary percutaneous coronary intervention during the COVID-19 pandemic.

Expert consensus on nursing management for patients undergoing primary percutaneous coronary intervention during the COVID-19 pandemic.

Contact precautions: no benefits, no indication

In view of the global increase in multidrug-resistant bacteria, applying contact precautions during the care of affected patients seems, at first, a rational approach to decrease the spread of these organisms. Increasing the distance between sources of multidrug-resistant organisms and potential recipients and using disposable equipment, such as gloves and gowns, for any contact with the patient and their environment might appear to be logical and harmless precautions. However, as a growing body of evidence has shown, contact precautions do harm.

A comparative carbon footprint analysis of disposable and reusable vaginal specula

Healthcare systems in the United States have increasingly turned toward the use of disposable medical equipment in an attempt to save time, lower costs, and reduce the transmission of infections. However, the use of disposable instruments is associated with increased solid waste production and may have negative impacts on the environment, such as increased greenhouse gas emissions. The purpose of this study was to inform this discussion; we applied life cycle assessment methods to evaluate the carbon footprints of 3 vaginal specula: a single-use acrylic model and 2 reusable stainless steel models. The functional unit of the study was defined as the completion of 20 gynecologic examinations by either type of speculum. The greenhouse gas emissions (eg, carbon dioxide, methane, nitrous oxide) across all life cycle stages, which includes material production and manufacturing, transportation, use and reprocessing, and end-of-life, were analyzed with the use of SimaPro life cycle assessment software and converted into carbon dioxide equivalents. The reusable stainless steel grade 304 speculum was found to have a lesser carbon footprint over multiple model scenarios (different reprocessing techniques, autoclave loading/efficiency, and number of uses) than either the reusable stainless steel grade 316 or the disposable acrylic specula. The material production and manufacturing phase contributed most heavily to the total life cycle carbon footprint of the acrylic speculum, whereas the use and reprocessing phase contributed most to the carbon footprints of both stainless steel specula. The use of disposable vaginal specula is associated with increased greenhouse gas equivalents compared with reusable alternatives with no significant difference in clinical utility. These findings can be used to inform decision-making by healthcare systems, because they weigh a wide range of considerations in making final purchase decisions; similar analytic methods can and should be applied to other components of health systems' waste streams.

Anesthesia practice in Covid-19 era: Unprecedented problems call for extraordinary solutions.

Anesthesia practice in Covid-19 era: Unprecedented problems call for extraordinary solutions.

Ugroženost stomatološkog osoblja SARS-CoV-2 virusom tokom stomatoloških intervencija

Introduction: The dental profession is a high-risk profession, considering the aspect of a possible 100% infection from patients who are carriers of bacterial, viral and fungal diseases during dental interventions. Aim: To perform the analysis of all data that explain the possibility of a SARS-CoV-2 virus infection in dental practice. Material and Methods: The literature data on the presence of SARS-CoV-2 virus, and its characteristics and behavior in the external environment and in living tissues was analyzed. Databases from the Medline, Cochrane Library, Science-Direct, EMBASE, and Google scholar libraries were used, as well as other sources of literature information about this virus. Results: SARS-CoV-2 is an RNA virus, which has a submicron size and the ability to survive in various environments. The retention of SARS-CoV-2 virus in air / aerosol lasts an average of 3 hours, while the half-life of this virus is 5 to 6 hours on stainless steel and 6 to 8 hours on plastic. Infected patients with SARS-CoV-2 virus develop COVID-19 disease, which manifests itself through presymptomatic, symptomatic and post-symptomatic periods of the disease. Conclusion: The SARS-CoV-2 virus can be found in aerosols generated by dental equipment, which uses compressed air for its work. Protection of dentists and staff from infection with the virus is possible by wearing an N95 respiratory mask with protection levels 2 and 3, which has a filtration efficiency, i.e. retention of submicron particles with an efficiency of ≥ 98%. Waterproof goggles with a protective visor or a special industrially designed facial visor in the form of a full face mask, which has its own motor for the supply of filtered air to the mask, and which prevents the contamination of the mucous membranes of the eyes, nose and mouth from liquid or solid aerosol in the air, need to be used. Other disposable protective equipment also must be waterproof. Korona virus izaziva prehladu kod ljudi, koja ima uobičajne simptome prehlade gornjih respiratornih puteva; zahvata nosnu šupljinu,a ponekad se širi i na ždrelo, larinks i sinuse 5,6,7 . Sa druge strane, SARS-CoV-2 virus, koji je izazivač masovne/globalne virusne infekcije, ima sličnosti sa druga dva korona virusa -beta korona virusom (SARS-CoV-1) i virusom srednjeistočnog respiratonog sindroma (MERS-CoV).

COVID Operation Theatre- Advisory and Position Statement of Indian Society of Anaesthesiologists (ISA National).

COVID Operation Theatre- Advisory and Position Statement of Indian Society of Anaesthesiologists (ISA National).

Forward and reverse supply chain network design for consumer medical supplies considering biological risk

Medical Supply chain network design is one of the crucial planning problems that if solved efficiently and effectively, can alleviate the dangers arising from the accumulation of wastes. Furthermore, the harmful effects of medical waste, with their infectious nature in the environment, have increased justifies the significance of this research. In this article, forward and reverse supply chain network design for consumer medical products is considered taking into account the biological risks. The proposed model has two objectives: first, maximizing the profit obtained from subtracting the costs from the revenues of the supply chain. Revenues are gained from selling medical supplies to hospitals and medical wastes to recycling centers, as well as getting the permission to use sterilize services from clinics lacking a sterilization center. The costs include activation cost of inventory, sterilization and collection centers, transportation cost, purchasing cost of medical supplies, municipality cost for destruction of medical waste, etc. The second objective is to reduce biological risks. The primary source of infectious medical supplies is from disposable supplies and equipment. Thus, the second objective function is to minimize the distance and travel time between the clinic and the sterilization center. The proposed model is implemented in hospitals in Tehran's 4th municipal district using the Bounded De Novo Programming approach which initially attempts to redesign rare sources of the problem. The issue has two types of resource and policy constraints. The policy constraints of the problem cannot be changed, which is why the bounded De Novo Programming approach is used to solve the problem. Redesigning the capacity of the sterilization center leads to the decrease of biological risks, and in addition to can causes to increasing profitability. Also, by raising the productivity of medical waste in the recycling process, the distribution center can receive more profits.