Sustainable device selection for flexible intubation scopes

Abstract

Medical device selection is currently based on criteria including clinical performance, usability, safety and procurement costs. Growing awareness of the negative contribution of the healthcare sector to the total greenhouse gas (GHG) emissions demands environmental sustainability to be taken into account as well. Reusable and disposable flexible intubation scopes are of current interest to anesthesiologists because disposables are often utilized due to their presumed superior sterility, cheaper purchasing price and convenience. Knowledge about the life cycle environmental impact of flexible intubation scopes is limited, so research is required to aid in sustainable device selection. Therefore, the goal of this study is to compare the environmental impact of disposable and reusable flexible intubation scopes and design a sustainable concept to enable data-driven selection of sustainable flexible intubation scopes. A cradle-to-grave comparative life cycle assessment (LCA) was made to quantify the environmental impact of reusable fiberoptic bronchoscopes (FOB) and disposable flexible video endoscopes (FVS) at 450 patient intubations. The largest contributors to the life cycle impact of the flexible intubation scopes were identified and used to generate a sustainable concept. The LCA results suggest that the reusable FOB has a lower life cycle impact in comparison to the disposable FVS, so selecting a reusable FOB is preferable from environmental perspective. Most life cycle emissions of the disposable FVS are caused by the material production of the device and manufacturing of the printed circuit board, while the disinfection process contributes most to the life cycle of the reusable FOB. The final concept of the sustainable flexible intubation scope contains plastic optical fibers and a thicker sleeve around the bending section of the insertion tube to make the device more durable and thus extend its lifetime. In order to minimize the environmental impact of flexible intubation scopes, it is recommended to develop flexible intubation scopes with plastic optical fibers, select low-impact materials for the device and revise the products’ life cycle at the product system level (e.g. disinfection process). Every small contribution towards a more sustainable healthcare system counts.