Reusable versus Single-Use Devices: Environmental, Economic, and Public Health Considerations
1 Describe in detail the device or technique.
US hospitals generate more than 5.9 million tons of medical waste annually. Reliance on single-use disposable (SUD) medical equipment is proliferating in the United States, often with the intent of reducing health care-associated infections though evidence of reduced risk is often lacking. The production, delivery, and waste management of SUDs may require significant quantities of materials and energy, which are themselves linked to emissions that affect public health and global climate change. Waste reduction can save money directly in expenditures, and indirectly through prevention of illness and loss of productivity.
Traditional criteria for the selection and purchase of medical devices include safety for patients and staff, efficacy and ease of use, and purchase and handling costs. Devices should also be compared along economic, environmental, and public health dimensions, using tools such as Life Cycle Costing (LCC) and Life Cycle Assessment (LCA) that consider the full cost and benefits of a product from cradle to grave. Exposures and impacts that occur during component material production, transportation, use, reprocessing/sterilization, and waste management of discarded devices are all included. Reusable and disposable models of several devices used in airway management have been compared in this way, including LMAs, laryngoscopes, and breathing circuits.
2 Where or when is this device or technique used in airway management?
LMA: Eckelman et al. performed an LCA comparing 40 uses of a reusable LMA to 40 disposable LMAs. Researchers found the reusable model to have fewer negative environmental effects in nearly all categories, typically contributing <50% of the impacts of single-use models. The largest source of greenhouse gas (GHG) emissions for the single-use LMAs (23%) is the production and polymerization of polyvinyl chloride (PVC). SUD LMAs are primarily made of PVC, with diethylhexyl phthalate (DEHP) softener additives. The American Medical Association is urging hospitals and health systems to reduce their use of PVC products, especially those containing DEHP, due to their toxic effects on public health. The majority (77%) of life cycle GHG emissions for the reusable LMA is through steam autoclaving. Changes in the design and processing of both models can yield efficiences—for reusables by optimizing loading of sterilization and for disposables by using alternative polymers.