Researchers Want Medical Industry to Reduce Waste, Reuse More Devices

The battle against single-use plastics has gained momentum in recent years, as people become more aware of the lasting environmental implications of using plastic items only once before throwing them away. There is growing pressure on companies to come up with reusable alternatives and ways of sterilizing them properly, and on individuals to provide their own containers and bags whenever they shop.

The health care industry is not exempt from these pressures. While it might seem like a surprising target for reusables (safety and sterility must always be the top priority), the Association of Medical Device Reprocessors (AMDR) says that hospitals could go a long way toward reducing their carbon footprints by rejecting the current "linear economy" model that normalizes single-use and embracing reusability on a greater scale. 

A new study, published in the journal Health Affairs, found that medical device reprocessing could have profound environmental benefits. A hospital's supply chain is responsible for approximately 80% of its emissions, and when hospitals have partnered with regulated reprocessors, it has led to meaningful improvements: "In 2018, medical device reprocessing diverted 15 million pounds of medical waste from landfills and saved healthcare institutions an estimated $470 million."

The kinds of devices most effectively reprocessed are considered to be of "mid-range complexity", described in Grist as "equipment like ultrasound probes, blood pressure cuffs, some kinds of forceps, and laparoscopic tools, all of which can be cleaned and reused." It does not include higher-risk items such as catheters, syringes, and needles.

Devising processes for reusing these items could even improve public health in general, suggests AMDR, as reducing waste creates a healthier world for all. Dan Vukelich, Esq. President and CEO of AMDR, told Treehugger, "Healthcare professionals are likely unaware that greenhouse gas emissions from hospitals are shortening lives and advancing climate change, and that single-use devices, when used once and thrown out, are a major cause of the problem." 

This echoes research published in The Lancet earlier in December, which reveals how the current climate crisis threatens to undermine many of the gains made in healthcare over the past 50 years. Grist cited Alan Weil, editor-in-chief of Health Affairs: "If you work in health care, there is a role in not just responding and adapting, but preventing the emissions that lead to climate change."

Reusing medical devices does precisely that, and according to Vukelich, wouldn't require major shifts in behaviors of health care workers. As he told Treehugger:

"The change is almost identical to adding a recycling program in your home. Your family needs to be trained to throw something in a different bin. The reprocessors come in and take the bin. It's not complicated. Healthcare workers need to change their mindset to see single-use devices as assets rather than trash."

Medical device reprocessing has been regulated by the FDA since 2000, in response to a surge in plastics use that occurred in the 1980s, driven partly by HIV infection rates and newly available cheap products from China. Vukelich lamented to Treehugger that "the pendulum never swung back toward durable, reusable equipment and instead has sadly maintained this wasteful, linear consumption and 'take-make-waste' pattern." But he maintains hope that the burgeoning medical reprocessing industry will continue to grow. So far the FDA has approved 300 different single-use items for regulated reprocessing.

Not everyone sounds as hopeful as Vukelich and the authors of the Health Affairs study. Treehugger spoke to Ben Reesor, manager of BLES Biochemicals, Inc., a Canadian pharmaceutical company, about its view of reusables. While pharmaceutical equipment differs from equipment used in hospitals, both are part of the broader medical industry. Reesor says he sees more of a trend toward single-use items and devices than away from them. He suggests two main reasons tied to cost and risk management.

Direct costs are a main driver, with global sourcing cheaper and easier than ever. Reesor admits the pandemic could change this, especially if device manufacturing moves closer to home, thus increasing labor costs, but he doesn't think it would be enough to dramatically change the reuse of certain supplies: "Most likely drug manufacturers would simply raise prices proportionate to the increased cost of production."

Indirect costs, however, are a bigger deterrent from reusables. The consequences of inadequately sterilized devices are too great to risk. Reesor offers the analogy of a $10 piece of tubing used to dispense a drug product. If he wants to reuse it, then he is responsible for cleaning and sterilizing between uses (which means a whole lot of paperwork), as well as ensuring that it doesn't degrade over time:

"The cost of sterilization by steam (autoclave) is also high due to large electricity and water use. So that $10 tubing that I could buy pre-sterilized and ready to use doesn't save me $10 each time I use it. I'd probably need to use it for years for it to make economical sense. The final indirect cost is the potential for liability and reputation damage. If we need to recall a batch due to bacteria contamination and we determine the root cause to be that $10 piece of tubing that we reuse each week we're very quickly in the red. Single-use reduces that risk to some degree."

Reesor says the implementation of tighter environmental policies and taxes on carbon and waste disposal could potentially push the industry toward greater reuse; but unfortunately, reusables cannot currently compete with the economics of single-use, at least not within a pharmaceutical laboratory.

When it comes to the smaller surgical kits and other devices used in hospitals, Vukelich isn't giving up. He believes the shift toward reusables will gain momentum as people understand its benefits. Just as we don't doubt the cleanliness of silverware at a restaurant, people should have a high level of confidence in reprocessors' ability to sterilize medical devices.

"Reprocessed devices are collected, sorted, labelled for tracking, cleaned, tested and inspected, then disinfected and/or sterilized, and returned to hospitals. The system is incredibly rigorous and thorough. All devices are proven to be as clean, functional and sterile as brand new."

The Health Affairs study authors call for product redesigns, for innovative ways to use old items, and for updated regulations that motivate medical device manufacturers to consider reuse. Over time, a shift toward greater circularity can happen, and public health will benefit as a result.