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Environmental and health outcomes of single-use versus reusable duodenoscopes

      Background and Aims

      The large-scale effects of duodenoscopes on the environment and public health have not been quantified. Our aim was to perform an exploratory life cycle assessment comparing environmental and human health effects of single-use duodenoscopes (SDs) and reusable duodenoscopes (RDs).

      Methods

      We evaluated 3 duodenoscopes: conventional RDs, RDs with disposable endcaps, and SDs. The primary outcomes were impacts on climate change and human health, complemented by multiple environmental impacts.

      Results

      Performing ERCP with SDs releases between 36.3 and 71.5 kg of CO2 equivalent, which is 24 to 47 times greater than using an RD (1.53 kg CO2) or an RD with disposable endcaps (1.54 kg CO2). Most of the impact of SDs comes from its manufacturing, which accounts for 91% to 96% of its greenhouse gas emission. The human health impact of RDs becomes comparable with the SD lower bound if disposable endcaps or other design modifications can reduce serious infection rates below a target rate of 23 cases per year (.0046%).

      Conclusions

      Although SDs may provide incremental public health benefit compared with RDs, it comes at a substantially higher cost to the environment. As infection rates continue to decrease from more regimented cleaning protocols and enhanced designs such as disposable endcaps to facilitate cleaning, the negative impact to human health from contaminated RDs could be comparable with SDs.

      Graphical abstract

      Abbreviations:

      FDA (U.S. Food and Drug Administration), GHG (greenhouse gas), LCA (life cycle assessment), RD (reusable duodenoscope), SD (single-use duodenoscope)
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      References

        • MacNeill A.J.
        • Hopf H.
        • Khanuja A.
        • et al.
        Transforming the medical device industry: road map to a circular economy.
        Health Affairs. 2020; 39: 2088-2097
      1. FDA Executive Summary 2019: Reducing the risk of infection from reprocessed duodenoscopes.
        (Available at:)
        https://www.fda.gov/media/132187/download
        Date accessed: June 11, 2021
      2. Senate Minority Report 2016: Preventable tragedies: superbugs and how ineffective monitoring of medical device safety fails patients.
        (Available at:)
        • Bang J.Y.
        • Sutton B.
        • Hawes R.
        • et al.
        Concept of disposable duodenoscope: At what cost?.
        Gut. 2019; 68: 1915-1917
        • Eckelman M.J.
        • Huang K.
        • Lagasse R.
        • et al.
        Health care pollution and public health damage in the United States: an update.
        Health Affairs. 2020; 39: 2071-2079
        • Namburar S.
        • von Renteln D.
        • Damianos J.
        • et al.
        Estimating the environmental impact of disposable endoscopic equipment and endoscopes.
        Gut. 2021; 71: 1326-1331
        • Davis N.F.
        • McGrath S.
        • Quinlan M.
        • et al.
        Carbon footprint in flexible ureteroscopy: a comparative study on the environmental impact of reusable and single-use ureteroscopes.
        J Endourol. 2018; 32: 214-217
        • McGain F.
        • Burnham J.P.
        • Lau R.
        • et al.
        The carbon footprint of treating patients with septic shock in the intensive care unit.
        Crit Care Resusc. 2018; 20: 304-312
        • Paoli C.J.
        • Reynolds M.A.
        • Sinha M.
        • et al.
        Epidemiology and costs of sepsis in the United States—an analysis based on timing of diagnosis and severity level.
        Crit Care Med. 2018; 46: 1889-1897
        • Huijbregts M.A.
        • Steinmann Z.J.
        • Elshout P.M.
        • et al.
        ReCiPe 2016: a harmonised life cycle impact assessment method at midpoint and endpoint level.
        Int J Life Cycle Assess. 2017; 22: 138-147
        • US Environmental Protection Agency
        Estimation Programs Interface Suite™ for Microsoft® Windows, V. 4.11. U.S. Environmental Protection Agency, Washington, DC2017
        • Fantke P.
        • Chiu W.A.
        • Aylward L.
        • et al.
        Exposure and toxicity characterization of chemical emissions and chemicals in products: global recommendations and implementation in USEtox.
        Int J Life Cycle Assess. 2021; 26: 899-915
        • Langerth A.
        • Isaksson B.
        • Karlson B.
        • et al.
        ERCP-related perforations: a population-based study of incidence, mortality, and risk factors.
        Surg Endosc. 2020; 34: 1939-1947
        • Global Burden of Disease Collaborative Network
        Global Burden of Disease Study 2016 (GBD 2016) Reference Life Table.
        Institute for Health Metrics and Evaluation, Seattle, WA2017
        • US Environmental Protection Agency
        Greenhouse gas emissions from a typical passenger vehicle.
        (Available at:)
        • Farach S.M.
        • Kelly K.N.
        • Farkas R.L.
        • et al.
        Have recent modifications of operating room attire policies decreased surgical site infections? An American College of Surgeons NSQIP review of 6,517 patients.
        J Am Coll Surg. 2018; 226: 804-813
        • Watts N.
        • Amann M.
        • Arnell N.
        • et al.
        The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate.
        Lancet. 2019; 394: 1836-1878
        • Sherman J.D.
        • Raibley L.A.
        • Eckelman M.J.
        Life cycle assessment and costing methods for device procurement: comparing reusable and single-use disposable laryngoscopes.
        Anesth Analg. 2018; 127: 434-443
        • Sørensen B.L.
        • Grüttner H.
        Comparative study on environmental impacts of reusable and single-use bronchoscopes.
        Am J Environ Protect. 2018; 7: 55-62
        • Cheema B.S.
        • Ghali M.
        • Schey R.
        • et al.
        Esophageal perforation after using a single-use disposable duodenoscope.
        Case Rep Gastroenterol. 2021; 15: 972-977

      Linked Article

      • Single-use duodenoscopes: How concerned should we be about the environment?
        Gastrointestinal EndoscopyVol. 96Issue 6
        • Preview
          Infection outbreaks related to contaminated duodenoscopes have caused considerable concern. Worldwide, 490 cases were reported between 2008 and 2018, and 32 patients died as a consequence.1 Although the overall mortality is extremely low (approximately 1:150,000),2 transmission of infection and death seem avoidable. Most outbreaks were attributed to nonadherence to the cleaning protocol, but duodenoscope design flaws were also identified.3,4 Consequently, industry and regulators looked for solutions to negate even the smallest risk of infection.
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