Environmental footprint and material composition comparison of single-use and reusable duodenoscopes

Abstract

Background Infection outbreaks associated with contaminated reusable duodenoscopes (RUDs) have induced the development of novel single-use duodenoscopes (SUDs). This study aimed to analyze the material composition and life cycle assessment (LCA) of RUDs and SUDs to assess the sustainability of global and partial SUD implementation.

Methods A single-center study evaluated material composition analysis and LCA of one RUD and two SUDs from different manufacturers (A/B). Material composition analysis was performed to evaluate the thermochemical properties of the duodenoscope components. The carbon footprint was calculated using environmental software. We compared the sustainability strategies of universal use of RUDs, frequent use of RUDs with occasional SUDs, and universal use of SUDs over the lifetime of one RUD.

Results RUDs were substantially heavier (3489 g) than both SUD-A (943 g) and SUD-B (716 g). RUDs were mainly metal alloys (95%), whereas SUDs were mainly plastic polymers and resins (70%–81%). The LCA demonstrated the sustainability of RUDs, with a life cycle carbon footprint 62–82 times lower than universal use of SUDs (152 vs. 10 512–12 640 kg CO²eq) and 10 times lower than occasional use of SUDs (152 vs. 1417–1677 kg CO²eq). Differences were observed between SUD-A and SUD-B (7.9 vs. 6.6 kg CO²eq per endoscope). End-of-life incineration emissions for SUDs were the greatest environmental contributors.

Conclusions Widespread adoption of SUDs has greater environmental challenges; it requires a balance between infection control and environmental responsibility. Carbon footprint labelling can help healthcare institutions make sustainable choices and promote environmentally responsible healthcare practices.

Publication History

Received: 22 January 2024

Accepted after revision: 10 July 2024

Accepted Manuscript online:
10 July 2024

Article published online:
03 September 2024

• References

• 1 Kim S, Russell D, Mohamadnejad M. et al. Risk factors associated with the transmission of carbapenem-resistant Enterobacteriaceae via contaminated duodenoscopes. Gastrointest Endosc 2016; 83: 1121-1129
• 2 Balan GG, Sfarti CV, Chiriac SA. et al. Duodenoscope-associated infections: a review. Eur J Clin Microbiol Infect Dis 2019; 38: 2205-2213 DOI: 10.1007/s10096-019-03671-3. (PMID: 31482418)
• 3 United States Food and Drug Administration. FDA Executive Summary: Infections associated with reprocessed duodenoscopes. Accessed July 31, 2024 at: www.fda.gov/medical-devices/reprocessing-reusable-medical-devices/infections-associated-reprocessed-duodenoscopes
• 4 Siau K, Hayee BH, Gayam S. Endoscopy's current carbon footprint. Tech Innov Gastrointest Endosc 2021; 23: 344-352
• 5 Pichler P-P, Jaccard IS, Weisz U. et al. International comparison of health care carbon footprints. Environ Res Lett 2019; 14: 064004
• 6 Maurice JB, Siau K, Sebastian S. et al. Green endoscopy: a call for sustainability in the midst of COVID-19. Lancet Gastroenterol Hepatol 2020; 5: 636-638 DOI: 10.1016/S2468-1253(20)30157-6. (PMID: 32553141)
• 7 Namburar S, von Renteln D, Damianos J. et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut 2022; 71: 1326
• 8 Lacroute J, Marcantoni J, Petitot S. et al. The carbon footprint of ambulatory gastrointestinal endoscopy. Endoscopy 2023; 55: 918-926 DOI: 10.1055/a-2088-4062. (PMID: 37156511)
• 9 Cunha Neves JA, Roseira J, Queirós P. et al. Targeted intervention to achieve waste reduction in gastrointestinal endoscopy. Gut 2023; 72: 306-313
• 10 Le NNT, Hernandez LV, Vakil N. et al. Environmental and health outcomes of single-use versus reusable duodenoscopes. Gastrointest Endosc 2022; 96: 1002-1008 DOI: 10.1016/j.gie.2022.06.014. (PMID: 35718068)
• 11 López-Muñoz P, Martín-Cabezuelo R, Lorenzo-Zúñiga V. et al. Life cycle assessment of routinely used endoscopic instruments and simple intervention to reduce our environmental impact. Gut 2023; 72: 1692-1697 DOI: 10.1136/gutjnl-2023-329544. (PMID: 37185655)
• 12 Kwakman JA, Poley MJ, Vos MC. et al. Single-use duodenoscopes compared with reusable duodenoscopes in patients carrying multidrug-resistant microorganisms: a break-even cost analysis. Endosc Int Open 2023; 11: E571-E580
• 13 Schoor A, Voor in 't holt A, Severin J. et al. Value of nontargeted screening for highly resistant microorganisms: the MOVE study. Infect Control Hosp Epidemiol 2020; 41: s429-s430
• 14 Martín-Cabezuelo R, Vilariño-Feltrer G, Campillo-Fernández AJ. et al. Materials science toolkit for carbon footprint assessment: a case study for endoscopic accessories of common use. ACS Environ Au 2023; 4: 42-50 DOI: 10.1021/acsenvironau.3c00044. (PMID: 38250342)
• 15 Leiden A, Cerdas F, Noriega D. et al. Life cycle assessment of a disposable and a reusable surgery instrument set for spinal fusion surgeries. Resour Conserv Recycl 2020; 156: 104704
• 16 Ditac G, Cottinet PJ, Quyen Le M. et al. Carbon footprint of atrial fibrillation catheter ablation. Europace 2023; 25: 331-340
• 17 Olympus Europa SE & CO, KG. Olympus Cleaner and Disinfectant. GA Process Chemistry. Accessed December 01, 2023 at: www.olympus.es/medical/rmt/media/es/Content/Content-MSD/Documents/Data-sheets/GA-process-chemistry-disinfectant_safety-data-sheet__001_V1_en_20120501.pdf
• 18 Department for Energy Security and Net Zero and Department for Business, Energy & Industrial Strategy (GOV.UK). Greenhouse gas reporting: conversion factors 2022 . www.gov.uk/government/publications/greenhouse-gas-reporting-conversion-factors-2022
• 19 Talibi SS, Scott T, Hussain RA. The environmental footprint of neurosurgery operations: an assessment of waste streams and the carbon footprint. Int J Environ Res Public Health 2022; 19: 5995 DOI: 10.3390/ijerph19105995. (PMID: 35627532)
• 20 Rizan C, Bhutta MF, Reed M. et al. The carbon footprint of waste streams in a UK hospital. J Clean Prod 2021; 286: 125446
• 21 Center for International Environmental Law. Plastic is carbon: unwrapping the ‘net zero’ myth (Oct 2021). Accessed July 31, 2024 at: www.ciel.org/reports/plastic-is-carbon-unwrapping-the-net-zero-myth/
• 22 United States Environmental Protection Agency. Greenhouse gas equivalencies calculator. Accessed July 31, 2024 at: www.epa.gov/energy/greenhouse-gas-equivalencies-calculator#results
• 23 Devasahayam S, Bhaskar Raju G, Mustansar Hussain C. Utilization and recycling of end of life plastics for sustainable and clean industrial processes including the iron and steel industry. Mater Sci Energy Technol 2019; 2: 634-646
• 24 United States Food and Drug Administration. Use duodenoscopes with innovative designs to enhance safety: FDA Safety Communication. Accessed July 31, 2024 at: www.fda.gov/medical-devices/safety-communications/use-duodenoscopes-innovative-designs-enhance-safety-fda-safety-communication
• 25 Bruno MJ, Beyna T, Carr-Locke D. et al. Global prospective case series of ERCPs using a single-use duodenoscope. Endoscopy 2023; 55: 1103-1114 DOI: 10.1055/a-2131-7180. (PMID: 37463599)
• 26 Andriulli A, Loperfido S, Napolitano G. et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007; 102: 1781-1788 DOI: 10.1111/j.1572-0241.2007.01279.x. (PMID: 17509029)
• 27 Bang JY, Sutton B, Hawes R. et al. Concept of disposable duodenoscope: at what cost?. Gut 2019; 68: 1915-1917
• 28 Ofstead CL, Buro BL, Hopkins KM. et al. Duodenoscope-associated infection prevention: A call for evidence-based decision making. Endosc Int Open 2020; 8: E1769-E1781 DOI: 10.1055/a-1264-7173. (PMID: 33269310)
• 29 Muthusamy VR, Bruno MJ, Kozarek RA. et al. Clinical evaluation of a single-use duodenoscope for endoscopic retrograde cholangiopancreatography. Clin Gastroenterol Hepatol 2020; 18: 2108-2117.e2103
• 30 Cunha Neves JA, Rodriguez de Santiago E, Pohl H. et al. Perspectives and awareness of endoscopy healthcare professionals on sustainable practices in gastrointestinal endoscopy: results of the LEAFGREEN survey. Endoscopy 2024; 56: 355-363
• 31 Rodríguez de Santiago E, Dinis-Ribeiro M, Pohl H. et al. Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2022; 54: 797-826
• 32 Pasqualino J, Meneses M, Castells F. The carbon footprint and energy consumption of beverage packaging selection and disposal. J Food Eng 2011; 103: 357-365
• 33 Dormer A, Finn DP, Ward P. et al. Carbon footprint analysis in plastics manufacturing. J Clean Prod 2013; 51: 133-141
• 34 García-Castellanos M, Lorenzo-Zúñiga V, Gayam S. et al. Clarifying approach to carbon footprint analysis in GI endoscopy – Comparison of an open access approach to professional analysis software. Endoscopy 2024; 56: S183
• 35 Bang JY, Hawes R, Varadarajulu S. Equivalent performance of single-use and reusable duodenoscopes in a randomised trial. Gut 2021; 70: 838-844 DOI: 10.1136/gutjnl-2020-321836. (PMID: 32895332)
• 36 Haddock R, de Latour R, Siau K. et al. Climate change and gastroenterology: planetary primum non nocere and how industry must help. Am J Gastroenterol 2022; 117: 394-400
• 37 Feucht Y, Zander K. Consumers' preferences for carbon labels and the underlying reasoning. A mixed methods approach in 6 European countries. J Clean Prod 2018; 178: 740-748