SM5002 Chap.8 Reusable and Single-Use Devices Compared

Reusable and Single-Use Devices Compared

Why this comparison keeps coming back

Once the life cycle method has been learned in software, the later lectures of the course turn it on real clinical choices: individual products in anaesthesia and intensive care, then procedures, products and processes in surgery. The most frequent question in that literature is whether a reusable device or its single-use counterpart carries the lower environmental burden.

It is a question procurement teams ask constantly, and the published answers are not uniform. Reading several case studies side by side is the fastest way to see which modelling choices decide the result.

Rigid laryngoscopes

A study at a large teaching hospital in the United States combined a cradle-to-grave assessment with life cycle costing for laryngoscope handles and blades.

The context was pressure from conflicting infection prevention guidance, which had pushed some institutions toward disposable devices or toward cleaning reusable ones more than required. Reusable steel components came out far ahead.

The disposable plastic handle carried roughly sixteen to eighteen times the greenhouse gas burden of a reusable handle given low-level disinfection, and the disposable plastic blade around five to six times that of a reusable blade given high-level disinfection. Costs pointed the same way, with disposables adding hundreds of thousands of dollars a year over 60,000 intubations.

Reusable handles broke even after only a handful of uses even when losses were allowed for. The authors also flagged excess cleaning as an avoidable impact.

Flexible cystoscopes

A urology study tracked a fleet of reusable flexible cystoscopes over many years to establish how many cases each device actually delivered before retirement. That durability figure transformed the manufacturing share.

A reusable scope is heavier and made of material with a higher manufacturing footprint per kilogram, yet once its manufacture is divided across thousands of procedures, the per-case share becomes tiny. The disposable scope carries its whole manufacturing burden on every case.

The totals were 2.40 kg CO2 per case for single-use and 0.53 kg for reusable, with reprocessing, both its energy and the protective equipment worn during it, making up nearly all of the reusable figure.

Earlier studies that had favoured disposables relied on short observation periods, which is exactly the input that understates lifetime use.

Central venous catheter insertion kits

An Australian study reached the opposite conclusion for a much simpler item.

The reusable kit was cheaper once labour was included, but its carbon footprint was about three times that of the single-use kit, and its water use was far higher. Sterilisation drove the reusable result, and the hospital's electricity came largely from brown coal. When the authors re-ran the model with other electricity supplies, the gap narrowed sharply, and with gas cogeneration the two options became close.

Their recommendation was to reduce the water and energy used in cleaning and sterilisation, not to abandon reuse.

Why cost and carbon are read together

Several of these studies pair life cycle assessment with life cycle costing, and the pairing is deliberate.

A procurement decision is rarely made on carbon alone, and a purchase price hides most of what a device costs over its life: labour for cleaning, reprocessing consumables, repairs, replacement of lost items and waste disposal.

Both the laryngoscope and catheter kit teams timed staff at work to measure the labour share, and the laryngoscope authors stress that this time-and-motion step is essential when reusable and disposable options are costed. When the carbon and the cost results point the same way, as with the laryngoscopes, the case for change is easy to make.

When they diverge, as with the catheter kits, where the reusable kit was cheaper but higher in carbon on a coal grid, the comparison shows exactly which lever, here the electricity supply, would align them.

Laparoscopic trocars

A Swedish study across three hospitals compared single-use, reusable and mixed trocar systems over a functional unit of 500 procedures, using a multi-category impact method and Monte Carlo simulation.

The single-use system had a much higher climate change impact and also scored worse on resources, ecosystem quality and human health. The mixed system, which combined reusable and disposable parts, performed much like the fully disposable option.

Several differences were sensitive to how fully the sterilisation machines were loaded.

Reading a reuse study critically

Comparisons of this kind are also a natural target for appraisal. Look first at the functional unit: per case, per procedure, or per batch of procedures, and whether both options deliver the same clinical function.

Then examine the assumed lifetime of the reusable device and where that number came from, whether a manufacturer rating, a short observation window, or years of records from a working fleet. Check the electricity mix and whether it was tested in a sensitivity analysis, and look for how full the sterilisers were assumed to run.

Finally, check which impact method was used and whether results beyond climate change were reported, since a device can win on carbon and lose on water or resource use. A study that reports uncertainty intervals, as several of these did through Monte Carlo analysis, lets you judge whether a small difference is meaningful at all.

What decides the sign

Taken together, the cases show that no general rule holds.

Four inputs keep deciding the outcome. The first is the number of uses a reusable device really achieves, including losses and repairs. The second is the carbon intensity of the electricity behind washing and sterilising. The third is how complex and material intensive the disposable version is to manufacture.

The fourth is how efficiently reprocessing is run, including machine loading and the level of cleaning actually needed. A well-read comparison names all four and states how sensitive the conclusion is to each. When one of them differs between a published study and your own hospital, the published verdict may not transfer.

What this chapter covers

• 01

  Where reusable versus single-use comparisons sit in the later lectures

• 02

  Laryngoscope handles and blades: life cycle assessment with life cycle costing

• 03

  Flexible cystoscopes: amortising manufacture over lifetime cases

• 04

  Central venous catheter kits: electricity source and a reversed verdict

• 05

  Laparoscopic trocars: single-use, reusable and mixed systems

• 06

  Four inputs that decide the direction of a reuse comparison

Worked example · free

Amortising a reusable cystoscope

Key terms

Single-Use Device

A medical device designed to be used on one patient and then discarded, carrying its full manufacturing burden on each use.

Reprocessing

Cleaning, disinfecting or sterilising a reusable device so it can be used on another patient, including the energy, water and protective equipment involved.

Life Cycle Costing

Counting the costs of an option across purchase, labour, reprocessing and disposal rather than at the point of sale alone.

Amortisation Over Uses

Dividing a reusable device's manufacturing footprint by the number of uses it actually delivers before retirement.

Gas Cogeneration

On-site combined generation of heat and power from gas, a lower carbon electricity source than brown coal in the catheter kit study.

Reusable and Single-Use Devices Compared FAQ

Assessment move

For each case paper, write down the functional unit, the assumed number of uses, the electricity source behind reprocessing and the headline result on a single index card. Then compare the cards and explain in two sentences why the catheter kit result runs the other way. Practise the cystoscope amortisation arithmetic until you can reproduce the per-case figure without notes.