Circular design is essential for better healthcare

The combination of expanding, ageing populations and rising rates of chronic diseases has produced an urgent need for sustainable care delivery strategies. This is worsened by high quantities of physical and nonphysical waste in health systems worldwide. Practice Greenhealth reports that hospitals generate 13 kg of garbage per bed every day, of which 15 to 25% is hazardous waste. Moreover, healthcare systems are responsible for 4% of worldwide CO2 emissions, greater than the global aviation or shipping industries. And we now know that reaching global climate targets is reliant on a more sustainable use of materials, i.e., a circular economy.

A circular healthcare economy

Few supply chain strategies simultaneously cut both prices and environmental effect. The phrase "circular economy" has been used to characterise solutions that eschew the traditional "take-make-dispose" strategy to resource consumption in favour of a regenerative one in which used products and energy are recovered and repurposed as inputs in another manufacturing process. The circular economy simultaneously cuts expenses and protects the environment.

The health sector is responsible for 4.6% of worldwide greenhouse gas emissions, more than a quarter of which are attributable to the American healthcare system. The linear (take-make-dispose) attitude to consuming is much more pronounced in the healthcare industry than in American culture as a whole. In a conventional healthcare economy, we extract materials from the environment, manufacture medical gadgets, use them in hospitals, and then discard them.

And why are we doing this? There are four major causes:

• First, the healthcare industry has a single-use mentality; it is safer to dispose of discarded medical gadgets. The notion is that discarding discarded medical devices reduces the risk of infection: the less we reuse, the safer it is.
• Second, reusing gadgets is challenging. Before reuse, they must be collected, transported, cleaned, tested, and sometimes sterilised. It is significantly simpler to discard the device after a single use and obtain a replacement.
• Third, many gadgets are so inexpensive, and the expenditure required to reuse them is so great, that reusing them is financially unfeasible.
• Fourthly, the device manufacturing sector has recognised that hospitals purchase more single-use gadgets, thus by developing devices for a single use, the producer optimises revenues.

However, present economic and supply chain challenges in the healthcare industry have demonstrated that the use-and-throw-away approach is not sustainable.

It is simply too expensive.

It is detrimental to the environment.

When demand increases – such as during the epidemic for particular types of devices – supplies cannot be located.

The circular healthcare economy must therefore be discussed. However, circular economy solutions in healthcare must overcome the aforementioned four obstacles. In this regard, there exists an illustration that can be utilised to illuminate the road forward across different supplier types.

Reprocessing of disposable devices

Reprocessing of single-use medical devices is undoubtedly the most successful and ubiquitous example of a circular economy in healthcare. Manufacturer-labeled "single-use" medical devices are collected and preserved following surgeries or other uses. A representative of the medical device reprocessing company collects the devices and sends them to the reprocessing facility. Here, they undergo tracing and registration, cleaning, testing, and sterilisation. The hospital may now obtain reconditioned gadgets for a tenth of the cost of a brand-new device. After reuse, devices are gathered and their components are recycled.

Already now, single-use device reprocessing provides hospitals in the United States with significant cost reductions. Utilizing reprocessed single-use gadgets enables hospitals to save more than $400 million annually. In cardiology, hospitals in the United States might collectively save $800 million annually by reprocessing. Some hospitals in the United States save more than $1 million annually by reprocessing Electrophysiology lab equipment. However, the savings potential has not yet been achieved in its entirety. According to some estimates, US hospitals might save an additional $500 million by maximising reprocessing.

However, recycling single-use devices does more than save hospitals money. It also benefits the environment and strengthens the supply chain. The Journal Health Affairs found in December 2017 that the health sector is "responsible for 4.6% of worldwide greenhouse gas emissions" and that "the vast bulk of health care's global greenhouse gas emissions originate in the supply chain." Reprocessing reduces hospital solid waste by around 6,000 tonnes per year in the United States.

But reprocessing requires transferring gadgets, employing chemicals to clean them, and transporting them back to hospitals - all of which have an impact on the environment. So, how much more environmentally friendly is a reprocessed device compared to a brand-new item? It becomes out that the environmental impact of reprocessed Electrophysiology catheters is less than HALF that of a new device.

Despite the usage of power and detergents in reprocessing, the influence of plastic production and other aspects on a new gadget makes reprocessed devices significantly less hazardous to the environment. Hospitals may minimise their environmental impact in a number of ways, but by utilising reprocessed devices instead of new ones, they can immediately cut their impact by 50 percent.

A road map to solutions for the circular economy

Reprocessing of single-use devices has been hindered by the inherent hurdles to circular economy solutions. And over the past two decades, the industry has surmounted these obstacles to build a procedure that saves hospitals substantial amounts of money and decreases their environmental effect.

• To attain comparable outcomes, the healthcare industry might utilise a reprocessing-based template by concentrating on the following:
• Determine which medical supplies are pricey and single-use. This may include medical instruments, as well as any number of consumables used in the hospital's cafeteria, transportation, visitor management, etc. Single-use gadgets are among the most costly healthcare supplies. The majority of items are not recycled.
• Perform a cost-benefit analysis to ensure that reusing does not incur additional expenses.
• Determine whether the selected supplies can be cleaned and reused safely. Many medical equipment and other supplies cannot be reused safely due to their design, their complexity, or patient safety hazards.
• Collaborate with hospital departments, manufacturers, reprocessing businesses, and other external partners to ensure that reprocessing and remanufacturing procedures are safe, operationally practicable, and cost-effective. In certain instances, this will need requiring manufacturers to modify their products or reprocessors to seek clearances for devices they were previously unable to reprocess: Many reprocessable devices are not currently being reprocessed.
• Create a collection of infrastructure and reuse it. This comprises collection containers for discarded goods, handling instructions, signage, new SOPs, and procedures for storing and buying back/reentering supplies into the inventory management system.
• Train the necessary personnel to comply with collection and re-use instructions, from collecting used materials through repurchasing and inventorying them.
• Require compliance with the reuse procedure. This is generally the most difficult step. Changing the routine of a hospital staff is difficult, especially because the personnel is frequently overworked.

Reprocessing is an established option for the circular economy. In fact, it may be the only effective example of a circular healthcare economy. This can be utilised by hospitals to generate extra cost savings and support a more sustainable healthcare system.

The 3rd Sustainable Development Goal (SDG3) aims at globally improving everyone’s health and well-being in the world, no matter their level of income, age, race, gender etc. According to the UN, despite significant strides made in increasing global life expectancy, inequalities in healthcare access still exist. More than 6 million children still die before their 5th birthday each year and only half of all women in developing regions have access to the healthcare they need.