Comparative Study on Environmental Impacts of Reusable and Single-Use Bronchoscopes
American Journal of Environmental Protection
Volume 7, Issue 4, August 2018, Pages: 55-62
Received: Aug. 17, 2018;
Accepted: Oct. 19, 2018;
Published: Nov. 15, 2018
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Birgitte Lilholt Sørensen, Centre for Life Cycle Engineering, University of Southern Denmark, Odense, Denmark
Henrik Grüttner, Centre for Life Cycle Engineering, University of Southern Denmark, Odense, Denmark
The introduction of single-use alternatives has stressed the need for environmental comparisons between reusable and single-use devises in the healthcare sector. Discarding of single-use devices intuitively causes concern among staff in hospitals, other users and people with environmental concerns as to whether the single use is environmentally friendly. This study aims to compare carbon dioxide (CO2)-equivalent emissions and resource consumption from a single-use bronchoscope (Ambu® aScopeTM 4) to a reusable flexible bronchoscope. The comparison is made using a simplified life-cycle-assessment methodology. The analysis shows that the materials used for the cleaning operations of the reusable scopes are a key factor affecting the impact factors assessed; energy consumption, emission of CO2-equivalent and consumption of scarce resources. Initially, it is assumed that each reusable scope is cleaned using one set of personal protective equipment (PPE) per cleaning operation, but since cleaning practice may vary the consequence of cleaning more scopes with one set of PPE is also assessed. Using one set of protective wear per operation and the materials for cleaning and disinfection determine that reusable scopes have comparable or higher material and energy consumption as well as higher emissions of CO2-equivalents and values of resource consumption. Cleaning two or more reusable scopes per set of PPE makes the impacts fairly comparable. Other aspects that may impact the results are also assessed, including energy consumption for washing and drying units, differences in use of PPE and differences in the disposal of PPE or single-use scopes. As the three assessed parameters are highly dependent on cleaning procedures and the use of protective equipment, it cannot be concluded from these results which type of bronchoscope affects the environmental factors investigated here the most.
Birgitte Lilholt Sørensen,
Comparative Study on Environmental Impacts of Reusable and Single-Use Bronchoscopes, American Journal of Environmental Protection.
Vol. 7, No. 4,
2018, pp. 55-62.
United Nations, SDG, “Sustainable Development Goals, 17 Goals to Transform our World,” 2015. [Online]. Available: https://www.un.org/sustainabledevelopment/sustainable-development-goals/. [Accessed 05 2018].
United Nations, Goal 13, “Take urgent action to combat climate change and its impacts,” 2015. [Online]. Available: https://www.un.org/sustainabledevelopment/climate-change-2/. [Accessed 5 2018].
United Nations, Goal 12, “Ensure sustainable consumption and production patterns,” 2015. [Online]. Available: https://www.un.org/sustainabledevelopment/sustainable-consumption-production/. [Accessed 5 2018].
D. C. Marshall, R. S. Dagaonkar, C. Yeow, A. T. Peters, S. K. Tan, D. Y. H. Tai, S. K. Gohs, A. Y. H. Lim, B. Ho, S. J. W. Lew, J. Abisheganaden and A. Verma, “Experience with the Use of Single-Use Disposable Bronchoscope in 11 the ICU in a Tertiary Referral Center of Singapore,” Journal of Bronchology & Interventional Pulmonolog, pp. 136-143, April 2017.
Intergovernmental Panel on Climate Change, “Climate Change 2014 Synthesis Report Summary for Policymakers,” 2014.
N. F. Davis, S. McGrath, M. Quinlan, G. Jack, N. Lawrentschuck and D. M. Bolton, “Carbon Footprint in Flexible Ureteroscopy; A Comparative Study on the Environmental Impact of Reusable and Single-Use Ureteroscopes,” Jour4nal of Endourology, vol. 32, no. 3, 2018.
S. Ibbotson, T. Dettmer, S. Kara and C. Herrmann, “Eco-efficiency of disposable and reusable surgical instruments - a sciccors case,” International Journal of Life Cycle Assessment, vol. 18, pp. 1137-1148, 2013.
F. McGain, D. Story, T. Lim and S. McAlister, “Financial and environmental costs of reusable and single-use anaesthestic equipment,” British Journal of Anaesthesia, pp. 862-869, 2017.
N. Campion, C. L. Thiel, N. C. Woods, L. Swanzy, A. E. Landis and M. M. Belic, “Sustainable healthcare and environmental life-cycle impacts of disposable supplies: a focus on disposable custom packs,” Journal of Cleaner Production, pp. 46-55, 2015.
M. F. Tvede, M. S. Kristensen and M. Nyhus-Andreasen, “A cost analysis of reusable and disposable flexible optical scopes for intubation,” ACTA ANAESTHESIOLOGICA SCANDINAVICA, pp. 577-584, 2012.
C. Viana, M. Vaccari and T. Tudor, “Recovering value from used medical instruments: A case study of laryngoscopes in England and Italy,” Resources, Conservation and Recycling, pp. 1-9, 2016.
R. A. McCahon and D. K. Whynes , “Cost comparison of re-usable and single-use fibrescopes in a large English teaching hospital,” ANAESTHESIA, pp. 699-706, 2015.
D. Gupta and H. Wang, "Cost-effectiveness analysis of flexible optical scopes for tracheal intubation: a descriptive comparative study of reusable and single-use scopes," Journal of Clinical Anesthesia, pp. 632-635, 2009.
S. Perbet, M. Blanquet, C. Mourgues, J. Delmas, S. Bertran, .. Longères, V. Boïko-Alaux, P. Chennell,, J.-E. Bazin and J.-M. Constantin, "Cost analysis of single-use (Ambu® aScope™) and reusable bronchoscopes in the ICU," ANNALS OF INTENSIVE CARE, 2017.
FORCE Technology, “End-of-Life Profile Ambu aScope EndoScopes,” 2017.
Association for the Advancement of Medical Instrumentation, “ANSI/AAMI ST91: 2015 Flexible and semi-rigid endoscope processing in health care facilities,” American National Standards Institute Inc., 2015.
K. Pommer, P. Bech, H. Wenzel, N. Caspersen and S. I. Olsen, Håndbog i miljøvurdering af produkter, Miljøstyrelsen, 2001.
K. Pommer, P. Bech, H. Wenzel, N. Caspersen and S. I. Olsen, Handbook on Environmental Assessment of Products, vol. 813, Danish Environmental Protection Agency, 2003.
Society of Gastroenterology Nurses and Associates, Inc., “Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes,” 2012.
Medivators Inc. Advantage Plus, “Medivators Advantage Plus Endoscope reprocessing system,” 2017.
Medivators Inc. ENDODRY™, “ENDODRY™ Storage and Drying System,” 2017.
Olympus, “EDC plus, Endoscope Drying Cabinet,” 2017.
A. f. t. A. o. M. Instrumentation, “ANSI/AAMI ST91: 2015 Flexible and semi-rigid endoscope processing in health care facilities,” American National Standards Institute Inc., 2015.
C. L. Ofstead, M. R. Quick, J. E. Eiland and S. J. Adams, "A glimpse of the true cost of reprocessing endoscopes: Results of a pilot project," 2017.