The impact of switching from single-use to reusable healthcare products: a transparency checklist and systematic review of life-cycle assessments

Abstract

Background Replacing single-use products with reusable ones may reduce the environmental impact of healthcare. This study aimed to broadly assess the environmental effects of that substitution. Methods A systematic review of comparative cradle-to-grave life-cycle assessments (LCAs) of single-use and reusable healthcare products was conducted. The main outcomes assessed were changes in the environmental impact that resulted after switching from single-use to reusable products. As no standardized transparency checklist was available, one was developed here using DIN ISO 14040/14044. The final checklist included 22 criteria used to appraise the included studies. Results After screening, 27 studies were included in the analysis. The healthcare products were assigned to four categories: invasive medical devices, non-invasive medical devices, protection equipment and inhalers. The outcomes revealed a reduction in mean effect sizes for all environmental impacts except water use. Non-invasive medical devices have greater relative mitigation potential than invasive devices. On average, information on 64% of the transparency checklist items was reported. Gaps included the reporting of data quality requirements. Conclusions Switching to reusable healthcare products is likely to reduce most impacts on the environment except water use, but the effect size differs among product categories. Possible study limitations include location bias, no systematic search of the grey literature and small samples for some impacts. This study’s strengths are its approach to product categories and developed transparency catalogue. This catalogue could be useful to inform and guide a future process towards creating a standardized transparency checklist for the systematic reviews of LCAs.

Tracing the barriers to decarbonising ophthalmology: A review

“…Other factors such as the location and method of manufacture, transport/energy used in production and greenhouse gas emissions should also be taken into consideration as locally manufactured items should be more sustainable. 113 There is an important conflict of interest in this area of study, as industry are motivated to sell single-use products, and have often highlighted and exaggerated the energy and water costs in cleaning and sterilising reusable products. Despite some outlier studies finding that cleaning a reusable device has a greater footprint than producing a single use device, 112 the preponderance supports the financial and environmental benefits of reusable products.…”

“…Despite some outlier studies finding that cleaning a reusable device has a greater footprint than producing a single use device, 112 the preponderance supports the financial and environmental benefits of reusable products. 108,109,111,113 These discrepancies are probably related to unrealistic costing of the sterilisation of reusable products. Although there are different methods of sterilisation, some of which are more resource intensive, the addition of an IOL injector to an existing tray of reusable instruments should not significantly affect the energy and water costs to autoclave that tray.…”

“…Sometimes it can be a difficult comparison because the embedded emissions in the production and supply of items are not commonly available for consideration, and the reusable products have higher up‐front costs and ongoing sterilisation costs while the comparable number of single‐use items is uncertain. Other factors such as the location and method of manufacture, transport/energy used in production and greenhouse gas emissions should also be taken into consideration as locally manufactured items should be more sustainable 113 . There is an important conflict of interest in this area of study, as industry are motivated to sell single‐use products, and have often highlighted and exaggerated the energy and water costs in cleaning and sterilising reusable products.…”

“…There is an important conflict of interest in this area of study, as industry are motivated to sell single‐use products, and have often highlighted and exaggerated the energy and water costs in cleaning and sterilising reusable products. Despite some outlier studies finding that cleaning a reusable device has a greater footprint than producing a single use device, 112 the preponderance supports the financial and environmental benefits of reusable products 108,109,111,113 . These discrepancies are probably related to unrealistic costing of the sterilisation of reusable products.…”

Misconceptions about sustainable anaesthesia

“…Opportunities exist to make these policies more widespread, and to apply the same scrutiny to other single‐use equipment such as laryngoscopes. By curtailing the manufacture of single‐use equipment, there is significant environmental benefit to be gained [16].…”