How to reuse medical products sustainably

The sustainability challenge in healthcare

There is growing recognition within the healthcare industry of the need to reduce carbon emissions and waste resulting from healthcare activities. In addition to the impact this can have on the planet and global warming, there is also a strong moral imperative to avoid creating climate related health problems for future generations. Estimates suggest that hospitals account for 39% of the healthcare industry’s emissions, with surgical operations contributing the most (surgical instruments alone account for up to 65% of global warming contributions from surgery)^[1]. Because of this, there have been numerous efforts to investigate the possibility of replacing disposable products
with reusable ones.

With appropriate cleaning and sterilisation protocols, reuse does not necessarily add any infection risk. A reusable medical tool can also be the cost-effective option, saving time and money from not having to manufacture a new one. There are therefore many advantages to developing reusable medical products and low carbon sterilisation processes that still retain their effectiveness, core function and benefits.

How sustainable is medical product sterilisation?

Various studies have provided important lessons on the sustainability of reusable medical products, by comparing the carbon footprint for single use (disposable) and multiple use (reusable) products. For example, in one study, the carbon footprint for both disposable and reusable instrument sets for spinal fusion surgeries were investigated and found that reusable surgical sets actually had a higher carbon footprint than the disposables^[1]. This was driven by the high carbon emissions from the autoclave sterilisation process, which outweighed the benefit of not needing to manufacture as many new sets when reusing products. Interestingly, the disposable sets were sterilised using gamma radiation and the carbon costs associated with this were minimal. If the reusable sets were switched to gamma sterilisation, this could offer a potential alternative path to making reuse the low carbon option.

A similar outcome was found by other analyses which compared the carbon footprint of reusable and single-use catheter insertion kits^[2]. It was found that steam-sterilised reusable kits had a much higher carbon footprint than disposable ones, with the steam sterilisation process accounting for 90% of the reusable kit carbon footprint. In this case, the disposable items were sterilised using ETO (ethylene oxide), which had a very low carbon footprint. ETO sterilisation could therefore provide another low carbon alternative to high temperature autoclave/steam sterilisation.

Another factor to consider in the sustainability of reusing medical products is that some medical device manufacturers specify disposable cleaning tools, in order to reduce the validation burden when cleaning and reprocessing their reusable medical devices. These single use, disposable cleaning tools will have a negative impact on the carbon footprint associated with those medical devices, perhaps negating any benefit from the devices being reusable.

How can we make medical product sterilisation more sustainable?

The goal is to allow the climate and waste reduction benefits of reusable products to be realised. The conclusions from the studies previously discussed explain that manufacturers and healthcare centres should seek to use gamma radiation or ETO where possible and avoid the use of high temperature processes like steam or autoclave. This has been exemplified for disposable and reusable cleanroom coveralls, which are both sterilised using low Global Warming Potential (GWP) gamma radiation^[3]. In this case, the reusable coveralls had a lower carbon footprint compared to single use, disposable items as well as a much smaller waste impact. ETO has the additional advantage of (typically) having a reduced impact on material properties compared to gamma radiation, thus prolonging product life.

In order to facilitate good uptake of the climate-friendly sterilisation options of ETO or gamma radiation, products need to be designed using materials suited to these processes wherever possible. Occupational safety and environmental standards are also required to be strictly adhered to during manufacture, use and disposal of any radiation source and ETO, otherwise the advantage of reduced carbon emissions may be undermined by other potential pollution from these activities. As well as this, any cleaning tools supplied with the device should be reusable. Finally, facilities for sterilisation of reusable items should be local to the end users, otherwise the carbon cost of transportation may outweigh the benefits of reuse.

It is clear that, with careful sterilisation process design, reusing more medical devices and instruments that are traditionally single use can help to reduce the negative impact of healthcare systems on the climate and plastic pollution.

References

[1] Leiden, A., Cerdas, F., Noriega, D., Beyerlein, J. and Herrmann, C., 2020. Life cycle assessment of a disposable and a reusable surgery instrument set for spinal fusion surgeries. Resources, Conservation and Recycling, 156, p.104704.

[2] McGain, F., McAlister, S., McGavin, A. and Story, D., 2012. A life cycle assessment of reusable and single-use central venous catheter insertion kits. Anesthesia & Analgesia, 114(5), pp.1073-1080.

[3] Vozzola, E., Overcash, M. and Griffing, E., 2018. Life cycle assessment of reusable and disposable cleanroom coveralls. PDA Journal of Pharmaceutical Science and Technology, 72(3).