Switching from single use instruments in UK to reusable healthcare supplies might be one way to reduce environmental impact. Reusable items may need less material and energy to manufacture and generate less trash. To minimize cross-contamination, reusable healthcare devices must be disinfected after each use, which may result in increased resource and energy consumption.
To prevent climate change and limit its repercussions, we must cut greenhouse gas emissions (GHGs). Given that Western nations’ healthcare systems account for 4-8% of their respective national GHG emissions,1 they provide an especially valuable target for climate change mitigation initiatives. Apart from global warming, healthcare systems contribute to additional environmentally harmful effects such as nitrous oxide emissions, sulfur dioxide emissions, and excessive water consumption.
Single Use Instruments in UK
Single Use Instruments in UK are discarded after one use, whereas reusable things may be used at least twice. Life-cycle assessment (LCA) is a quantitative and all-encompassing tool for assessing environmental consequences. An LCA examines a product over its whole life cycle, preferably from cradle to death. The ISO standards 14040 and 14044 specify and explain LCAs.
We conducted a systematic review as closely as feasible to the recommended reporting items for the systematic reviews and meta-analyses (PRISMA) framework, which was established for systematic reviews and meta-analyses of clinical research. We employed an existing standardized approach for reviewing and reporting LCA data reviews in addition to the PRISMA framework (STARR-LCA). These checklists are available in Supplemental Appendix S1.
Strategy for Search:
Supplemental appendix S2 contains full Boolean search strings customized to the selected databases. We picked three databases to cover all scientific channels where LCAs of healthcare commodities may have been published: PubMed, ProQuest, and Web of Science. On September 9, 2021, a database search was conducted. Throughout the full-text evaluation, more material was considered/added using an iterative reference tracking procedure. Search alerts were utilized to ensure that no studies published after this date was missed.
The screening procedure was carried out in two stages by two reviewers (M.K. and K.H.). The first stage was a title-abstract screening of all studies found in the database search, followed by a full-text review. Before proceeding to the next level, screenings were conducted separately and compared. Disagreements were settled by debate and consensus among both reviewers.
Studies were included if they were written in English or German, compared single use Instruments in UK to reusable healthcare goods with equivalent functions, and presented quantifiable results for at least one category of environmental effect. Studies that did not include a complete cradle-to-grave examination were eliminated. According to the World Health Organization’s system of health accounting, healthcare products are items or services that fall inside the core healthcare category.
Extraction and coding of data:
M.K. retrieved the entire life-cycle-impact data for both reusable and single-use instruments in UK from each investigation. So long as quantifiable findings were published, all relevant data, including sensitivity and scenario assessments, were utilized. If different scenarios for the Single Use Instruments option were given, a cautious evaluation was used, and the scenario with the least environmental effect was chosen. This was done to eliminate bias toward reusable items and to ensure that all mitigation potential from One Use Instruments is used. The reference region was documented to study location bias. Lastly, bibliographic data such as year of publication and product information were retrieved.
A critical evaluation:
A standardized checklist is often used to critically evaluate research in systematic reviews (e.g. CHEERS checklist for health economic evaluations). In a deliberative process, a range of parties creates such checklists. Unfortunately, no standardized checklist for LCAs was found. As a result, a checklist was developed here, based on the standards DIN ISO 14040 and DIN ISO 14044, and geared toward Lange et alchecklist .’s for carbon footprint assessments. Our suggested checklist intends to investigate transparency in the communication of methodologies, outcomes, and potential biases; it comprises 22 criteria organized into five categories based on the LCA stages (explained in detail in Supplementary Appendix S3).
The database search yielded a total of 2458 results. Following the removal of 1218 duplicates, 1240 studies were included for title-abstract screening, from which 1146 records were eliminated, leaving 94 records for retrieval and eligibility evaluation. All 94 records were retrieved, however, 75 were excluded: 1 due to a language barrier, 31 due to a lack of original study, 39 due to a lack of comparison of reusable and Single Use Instrumentation in UK healthcare items, and 4 due to a lack of quantitative data. Another research was removed because it was a pre-print version of a previously vetted peer-reviewed manuscript. While Dettenkofer et al. looked to match the inclusion requirements, they were eliminated due to a 9-year time gap (Dettenkofer et al. published in 199913; Carre published in 2008) and poor transparency criteria fulfillment (29.55%). As a result of the database search, 18 records were eventually included in our systematic review and meta-analysis. Four more records were discovered and included in search updates.