Environmental Impact of Reusable and Disposable Surgical Forceps Consumption at the Hospital of The University of Pennsylvania
With the opening of its new $80 million sterilization facility, the largest in the country, Penn has continued to distance its hospital system away from disposable surgical tools and towards a more closed economy of reusable tools. With the new plant, Penn will be able to cut down on the purchasing of 15,500 disposable polyethylene surgical forceps per year and reuse steel forceps instead. The goal of this thesis was to eventually answer the questions of whether Penn’s shift in consumption is more beneficial in terms of sustainability than the alternative. More specifically, with Penn’s new investments in sterilization procedures, this investigation sought to conclude the precise change in environmental impact associated with lower disposable tool consumption and increased sterilization procedures.
To quantify environmental affect from the tools, a life cycle assessment was performed for both reusable and disposable surgical forceps using openLCA software. Forceps were chosen because they are among the most commonly purchased surgical tools within HUP, and would their purchasing levels would thus be most affected by the new sterilization facility. Life cycle assessments track all inputs and outputs within each stage of a product, including material extraction, manufacturing, processing, transport, use, and disposal. Using a life cycle assessment, environmental impact can be deduced by cataloguing all inputs derived from the environment at every stage of upstream, downstream, and direct production, while tracking resultant outputs. The methods database utilized in openLCA was impactWorld+ version 6, and the output database was Agribalyse version 3. Data on Penn’s annual surgical tool consumption was obtained from Penn’s Hospital Finance Office, and information on the precise weights and measurements for each tool were provided by their respective manufacturers. Each life cycle is conducted using a single functional unit for each product, meaning that the environmental impact of the actual forceps is tracked, as well as all associated processes up to the retirement of the product including disposal, reuse, and sterilization. Assessments for each tool were scaled up to track impact of additional consumption of steel tools, and impact of reduction in consumption of plastic tools. The results of the life cycle assessments revealed that for almost all metrics, steel forceps fare better than the alternative, even with the repeated sterilization procedures. In terms of global warming potential, utilizing disposable forceps for every new surgery contributes 200x more greenhouse gas potential than does the use of reusable forceps. Other major reductions in environmental impact from reusable tools are from terrestrial ecotoxicity, ozone layer depletion, non-renewable energy use, and carcinogenic emissions.
The results of this study could allow HUP to appropriately plan for more sustainable operation with an idea of the environmental costs and benefits of transitioning towards reusable tools. The life cycle assessments conducted in this study did not take into account the social or economic effects of both methods of consumption, which were out of scope for this investigation but could be a further area of study. In addition, acting as a limit to this study is that several assumptions were made within the life cycle assessments including the energy use within the production processes, the origins of the American steel and polyethylene, and the transport distances between stages of the life cycles.