Skip to main content

Eco-efficiency of disposable and reusable surgical instruments—a scissors case

Abstract

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 sterilisation 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 externalised environmental costs in the case of the disposable steel product.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Abbreviations

CED:

Cumulative energy demand

E/E:

Eco-efficiency

GRP:

Glass-reinforced plastics

LCA:

Life cycle assessment

LCIA:

Life cycle impact assessment

LCI:

Life cycle inventory

TCO:

Total cost of ownership

WBCSD:

World business council for sustainable development

WRE:

World ReCiPe midpoint

WRM:

World ReCiPe endpoint

References

  1. Adler S, Scherrer M, Rückauer KD, Daschner FD (2005) Comparison of economic and environmental impacts between disposable and reusable instruments for laparoscopic cholecystectomy. Surg Endosc 19:268–272

    Article  CAS  Google Scholar 

  2. Aoe T (2007) Eco-efficiency and ecodesign in electrical and electronic products. J Clean Prod 15:1406–1414

    Article  Google Scholar 

  3. Apelgre KN, Blank ML, Slomski CA, Hadjis NS (1994) Reusable instruments are more cost-effective than disposable instruments for laparoscopic holecystectomy. Surg Endosc 8:32–34

    Article  Google Scholar 

  4. Baykasoglu A, Dereli T, Yilankirkan N (2009) Application of cost/benefit analysis for surgical gown and drape selection: a case study. Am J Infect Control 37:215–226

    Article  Google Scholar 

  5. Belboom S, Renzoni R, Verjans B, Léonard A, Germain A (2011) A life cycle assessment of injectable drug primary packaging: comparing the traditional process in glass vials with the closed vial technology (polymer vials). Int J Life Cycle Assess 16:159–167

    Article  CAS  Google Scholar 

  6. Blanchard BS (1978) Design and manage to life cycle cost. Virginia Polytechnic Institute and State University, Portland, M/A Press

  7. Bribián IZ, Capilla AV, Usón AA (2011) Life cycle assessment of building materials: comparative analysis of energy and environmental impacts and evaluation of the eco-efficiency improvement potential. Build Environ 46(5):1133–1140

    Article  Google Scholar 

  8. Campion N, Thiel CL, DeBlois J, Woods NC, Landis AE, Bilec MM (2012) Life cycle assessment perspectives on delivering an infant in the US. Sci Total Environ 425:191–198

    Article  CAS  Google Scholar 

  9. Conrady J, Hillanbrand M, Myers S, Nussbaum G (2010) Reducing medical waste. AORN J 91:711–721

    Article  Google Scholar 

  10. DIN EN 285:2009-08: Sterilization—steam sterilizers—large sterilizers. German version EN 285:2006+A2:2009

  11. EHS Medizintechnik (2009) Aesculap SUSI-Eine Kosten-Nutzen-Analyse, http://www.ehs.de/home/fachdisziplinen-produkte/zentralsterilisation/aesculap-susi/susi-kosten-nutzen-analyse.html. Accessed 3 October 2012

  12. Environmental Protection Agency (2002) European waste catalogue and hazardous waste list. Valid from 1 January 2002, ISBN: 1-84095-083-8, Ireland

  13. Frischknecht R, Jungbluth N, Althaus H-J, Doka G, Dones R, Hischier R, Hellweg S, Nemecek T, Rebiter G, Spielmann M (2007) Overview and methodology. Final report Ecoinvent data v2.0 No.1. Swiss Centre for Life Cycle Inventories, Duebendorf, Switzerland

  14. Gilden DJ, Scissors KN, Reuler JB (1992) Disposable products in the hospital waste stream. West J Med 156:269–272

    CAS  Google Scholar 

  15. Goedkoop M, Heijungs R, Huijbregts M, Schryver AD, Struijs J, Van Zelm R (2009) ReCiPe 2008. A life cycle impact assessment method which comprises harmonised category indicators at the midpoint and the endpoint level. VROM, The Hague

    Google Scholar 

  16. Herrmann C (2010) Ganzheitliches Life-Cycle-Management-Nachhaltigkeit und Lebenszyklusorientierung in Unternehmen. Springer, Berlin

    Book  Google Scholar 

  17. International Energy Agency (2010a) Electricity/heat in 2010. www.iea.org/stats/index.asp. Accessed 4 September 2012

  18. International Energy Agency (2010b) CO2 emissions from fuel combustion highlights, 2010th edn. IEA, Paris

    Google Scholar 

  19. ISO 14040 (2006) Environmental management—life cycle assessment—principles and framework. ISO, Geneva

    Google Scholar 

  20. Jones CI, McManus MC (2010) Life-cycle assessment of 11 kV electrical overhead lines and underground cables. J Clean Prod 18:1464–1477

    Article  Google Scholar 

  21. Kerr W, Ryan C (2001) Eco-efficiency gains from remanufacturing: a case study of photocopier remanufacturing at Fuji Xerox Australia. J Clean Prod 9(1):75–81

    Article  Google Scholar 

  22. Klar M, Haberstroh J, Timme S, Fritzsch G, Gitsch G, Denschlag D (2011) Comparison of a reusable with a disposable vessel-sealing device in a sheep model: efficacy and costs. Fertil Steril 95:795–798

    Article  Google Scholar 

  23. Kummerer K, Dettenkofer M, Scherrer M (1996) Comparison of reusable and disposable laparotomy pads. Int J Life Cycle Assess 1:67–73

    Article  Google Scholar 

  24. Laustsen G (2007) Reduce–recycle–reuse: guidelines for promoting perioperative waste management. AORN J 85(4):717–728

    Article  Google Scholar 

  25. Lyrstedt F (2005) Measuring eco-efficiency by a LCC/LCA ratio an evaluation of its applicability A case study at ABB. MSc. Thesis, Chalmers University of Technology

  26. McGain F, McAlister S, McGavin A, Story D (2010) The financial and environmental costs of reusable and single-use plastic anaesthetic drug trays. Anaesth Intensive Care 38:538–544

    CAS  Google Scholar 

  27. Mercateo (2012) Chirurgische schere bei mercateo online kaufen. Mercateo Deutschland, http://www.mercateo.com/kw/chirurgische%2820%29schere/chirurgische_schere.html. Accessed 28 September 2012

  28. Michelsen O, Fet AM, Dahlsrud A (2006) Eco-efficiency in extended supply chains: a case study of furniture production. J Environ Manag 79:290–297

    Article  Google Scholar 

  29. Morrison JE, Jacobs VR (2004) Replacement of expensive, disposable instruments with old-fashioned surgical techniques for improved cost-effectiveness in laparoscopic hysterectomy. JSLS 8:201–206

    Google Scholar 

  30. Oikawa S, Ebisu K, Fuse K (2005) Fujitsu’s approach for eco-efficiency factor. Fujitsu Sci Tech J 41(2):236–241

    CAS  Google Scholar 

  31. Overcash M (2012) A comparison of reusable and disposable perioperative textiles: sustainability state-of-the-art. Anesth Analg 114(5):1055–1066

    Article  Google Scholar 

  32. Park PJ, Tahara K (2008) Quantifying producer and consumer-based eco-efficiencies for the identification of key ecodesign issues. J Clean Prod 16:95–104

    Article  Google Scholar 

  33. PRe Consultants BV (2008) SimaPro 7 user’s manual. The Netherlands

  34. Rattanapana C, Suksaroj TT, Ounsaneha W (2012) Development of eco-efficiency indicators for rubber glove product by material flow analysis. Procedia - Social Behav Sci 40:99–106

    Article  Google Scholar 

  35. Recipe, introduction (2011) http://sites.google.com/site/lciarecipe/project-definition. Accessed 4 September 2012

  36. Saling P, Kircherer A, Dittrich-Krämer B, Wittlinger R, Zombik W, Schmidt I, Schrott W, Schmidt S (2002) Eco-efficiency analysis by BASF: the method. Int J Life Cycle Assess 7(4):203–218

    Article  Google Scholar 

  37. Schooleman S (1993) OR industry split on merits of disposable/reusable instruments. Health Ind Today 56(5):1

    Google Scholar 

  38. Schubert K (2009) Abfallmanagement an einem krankenhaus mit maximalversorgung - ein praxisbericht. presentation at 5. Umwelttag NRW – Bochum 15.09.2009, http://www.ak-umwelt-im-krankenhaus.de/unterlagen/umwelttag/2009/Vortragsunterlagen/WS%204_5%20schubert%20Vortrag%20Bochum%2015092009.pdf. Accessed 28 September 2012

  39. Schulz J, Pschorn J, Kara S, Herrmann C, Ibbotson S, Dettmer T, Luger T (2011) Environmental footprint of single-use surgical instruments in comparison with multi-use surgical instruments. 18th CIRP Conference on Life Cycle Engineering, Braunschweig, Germany, pp 623–628

  40. Silalertruksa T, Sébastien Bonnet S, Gheewala SH (2012) Life cycle costing and externalities of palm oil biodiesel in Thailand. J Clean Prod 28:225–232

    Article  CAS  Google Scholar 

  41. Sisolefyky J (2012) Written communication. Vanguard Integrierte Verorgungssysteme GmbH, Accessed 28 August 2012

  42. van Middelaar CE, Berentsen PBM, Dolman MA, de Boer IJM (2011) Eco-efficiency in the production chain of Dutch semi-hard cheese. Livest Sci 139:91–99

    Article  Google Scholar 

  43. Vercalsteren A, Spirinckx C, Geerken T (2010) Life cycle assessment and eco-efficiency analysis of drinking cups used at public events. Int J Life Cycle Assess 15:221–230

    Article  CAS  Google Scholar 

  44. WBCSD (2000) Eco-efficiency—creating more value with less impact, ISBN 2-940240-17-5, http://www.wbcsd.org/web/publications/eco_efficiency_creating_more_value.pdf. Accessed 28 September 2012

  45. Wübbenhorst K (1984) Konzept der lebenszykluskosten. Grundlagen, Problemstellungen und technologische Zusammenhänge. Verlag für Fachliteratur Darmstadt, Darmstadt, Germany

Download references

Acknowledgments

The authors especially thank Jörg Sisolefsky (Vanguard Integrierte Verorgungssysteme GmbH) for his contribution to this study.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Suphunnika Ibbotson.

Additional information

Responsible editor: Marzia Traverso

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ibbotson, S., Dettmer, T., Kara, S. et al. Eco-efficiency of disposable and reusable surgical instruments—a scissors case. Int J Life Cycle Assess 18, 1137–1148 (2013). https://doi.org/10.1007/s11367-013-0547-7

Download citation

Keywords

  • Cradle-to-grave
  • Eco-efficiency
  • LCA
  • LCC
  • Surgical scissors