Eco-efficiency of disposable and reusable surgical instruments

Purpose
In recent years, the rising costs and infection control lead to an increasing use of disposable surgical instruments in daily hospital practices. Environmental impacts have risen as a result across the life cycle of plastic or stainless steel disposables. Compared with the conventional reusable products, different qualities and quantities of disposable scissors have to be taken into account. An eco-efficiency analysis can shed some light for the potential contribution of those products towards a sustainable development.

Methods
Disposable scissors made of either stainless steel or fibre-reinforced plastic were compared with reusable stainless steel scissors for 4,500 use cycles of surgical scissors used in Germany. A screening life cycle assessment (LCA) and a life cycle costing were performed by following ISO 14040 procedure and total cost of ownership (TCO) from a customer perspective, respectively. Subsequently, their results were used to conduct an eco-efficiency analysis.

Results and discussion

The screening LCA showed a clear ranking regarding the environmental impacts of the three types of scissors. The impacts of the disposable steel product exceeds those of the two others by 80 % (disposable plastic scissors) and 99 % (reusable steel scissors), respectively. Differences in TCO were smaller, however, revealing significant economic advantages of the reusable stainless steel product under the constraints and assumptions of this case study. Accordingly, the reusable stainless steel product was revealed as the most eco-efficient choice. It was followed by the plastic scissors which turned out to be significantly more environmentally sound than the disposable stainless steel scissors but also more cost-intensive.

Conclusions

The overall results of the study prove to be robust against variations of critical parameters for the prescribed case study. The sensitivity analyses were also conducted for LCA and TCO results. LCA results are shown to be reliable throughout all assumptions and data uncertainties. TCO results are more dependent on the choice of case study parameters whereby the price of the disposable products can severely influence the comparison of the stainless steel and the plastic scissors. The costs related to the sterilization of the reusable product are strongly case-specific and can reduce the economic benefit of the reusable scissors to zero. Differences in environmental and economic break-even analyses underline the comparatively high share of externalized environmental costs in the case of the disposable steel product.

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