Circular Economy in Medical Device Reprocessing

The resource use associated with health care facilities has a large environmental impact, accounting for 4.4–4.6% of worldwide greenhouse gas emissions.^{1, 2} This resource use includes single-use medical devices, which health care facilities have become increasingly reliant upon.² These disposable devices are associated with a high volume of waste, the incineration or landfill of which subsequently generates large volumes of air, water and soil pollution, which contribute to environmental damage whilst having a negative effect upon health-related outcomes.^{2, 3}

In order to reduce the environmental impact of health care-related waste, and reduce the exploitation of natural resources, there is a need for innovative business models which seek to reduce resource use whilst maintaining economic value.

In a linear economy, resources are extracted on a large scale and are subsequently disposed of once they have fulfilled their purpose. This is typically carried out with the intention of maximising profit. However, this approach does not consider the subsequent environmental damage, resulting from the overexploitation of natural resources and the generation of pollution.⁴

In contrast, a circular economy places an emphasis upon sustainability. This approach aims to minimise resource use and extraction, support longer-term use of resources, optimise resource recovery through high-quality recycling, prevent pollution and support the regeneration of ecosystems, whilst creating equitable economic and social value.⁵ Several circular economy strategies can be employed to improve the focus upon sustainability within health care; owing to the high prevalence of single-use medical devices,² the ‘re-use’ of materials or resources is a particularly relevant approach for health care providers to consider.⁶

To ensure the successful re-use of medical devices, reprocessing within a hospital’s central sterile services department is required. This is vital in order to reduce the risk of medical device contamination and subsequent patient exposure to hospital acquired infections.7 Whilst this exposure to infection compromises patient safety, it is also associated with an increased carbon footprint through increased patient hospitalisation and resource use.⁷

The implementation of circular practices, such as the reprocessing of medical devices, has several benefits:

• Reduced environmental impact: A high proportion of health care-associated greenhouse gas emissions can be attributed to the supply chain; medical equipment manufacturing is responsible for 19% of the UK NHS’s carbon footprint.⁸ The introduction of reusable medical devices reduces energy use, which subsequently reduces air and soil pollution.³ Furthermore, the re-use of medical devices substantially reduces the amount of waste produced. In 2019, 15,292,928 pounds of medical waste was diverted from landfills as a result of the use of reprocessed, single-use medical devices.⁹ 
• Improved health-related outcomes: Due to reduced emissions and subsequent pollution, it is predicted that air, soil and water quality will improve. It is anticipated that this will have a positive impact on health-related outcomes, including a reduction in cancers, negative birth outcomes and respiratory diseases.³
• Economic savings: Whilst a linear approach is typically employed with profit in mind, the re-use of medical devices is associated with significant cost savings. In 2019, $21,724,304 was saved through reduced waste disposal by hospitals that reprocessed single-use medical devices.⁹

To maximise cost-effectiveness within a circular economy, it is important to identify the appropriate approach to medical device sterilization. Given the continually increasing cost of resources,¹³ energy consumption is a vital factor to consider when assessing the viability of a particular sterilization modality. Whilst low temperature sterilization requires the use of disposables,^{10, 11} it is also associated with reduced water and energy consumption in comparison to steam sterilization. This was highlighted in a study assessing the environmental and economic impact of sterilization systems, whereby hydrogen peroxide gas plasma sterilizers required less energy in comparison to steam sterilization, with consumption of 3.7–10 kWh/year compared to 32.1 kWh/year respectively.¹²

Alongside energy consumption, it is also important to consider the impact a sterilant has on medical device longevity. Several devices can be affected by the high temperatures and humidity from steam sterilization, which can result in increased device damage leading to costly repair or replacement, both of which subsequently increasing energy consumption. To reduce the impact a sterilant has on the wear of a material, the use of low temperature sterilization may be suitable. This was demonstrated in an economic analysis, whereby a 58% reduction in the number of repairs per sterilization procedure was shown with low temperature sterilization, in comparison to steam sterilizers.¹⁴

ASP aims to support a circular approach to health care via the STERRAD™ Systems with ALLClear™ Technology. These systems utilise low temperature hydrogen peroxide gas plasma to efficiently sterilize a large range of medical devices:¹⁵

• In comparison to autoclave steam sterilizers, STERRAD™ Systems reduce the annual consumption of energy and water by approximately 70% and 180,000 litres, respectively. Energy consumption is further optimised by ALLClear™ Technology, which rapidly detects and corrects load and system issues to subsequently reduce cycle interruptions and cancellations
• To reduce the cost and energy consumption associated with medical device repair and replacement, the low temperature approach of the STERRAD™ Systems preserves instrument integrity.