Sustainable healthcare


a 28% reduction in energy consumption, a 30% reduction in greenhouse gas emissions, a 41% reduction in blue water consumption, and a 93% reduction in solid waste generation’. This comprehensive assessment provides


strong evidence in favour of reusable products and their sustainability benefits, and a number of other studies support this view, with a general conclusion that the climate change impact of a reusable gown is around 30% of that of a disposable gown. One of the earliest life cycle assessments of hospital gowns in 2008,6 also carried out in the US, found that climate change impact was significantly decreased for a reusable gown, while a further American study by Jewell7


considered a range of reuse rates, based on hospital data, finding that for reusable gowns the impacts are driven by the washing and manufacturing, whereas the disposable gown impacts were mainly due to raw materials and manufacturing. It is important to bear in mind that these studies focus on products which are representative of the US market. Subtle regional variations in aspects such as product materials, manufacturing and reprocessing techniques mean it has not therefore been possible to say with certainty whether these results accurately translate to disposable and reusable products available elsewhere. In the UK, a recent study by Rizan et al 8


reported the environmental impact of personal protective equipment distributed for use by health and social care services in England in the first six months of the COVID-19 pandemic. This used energy, water and detergent requirements from literature to estimate that a reusable gown, used 75 times and with a transport cleaning round trip of 160km, has a climate change impact of around 32% of a disposable alternative. This approximation again points in favour of reusables, but there have been no UK- based studies modelled on practical, real-life scenarios – until now.


The first ever UK-based surgical gown life cycle analysis Conducted independently by The Grantham Centre for Sustainable Futures – a collaboration between The Grantham Foundation for the Protection of the Environment and The University of Sheffield – the research was carried out in compliance with ISO14040. The results provide a


In countries such as Sweden, Norway and the Netherlands, there is a tax on incineration, and it is likely other countries may adopt a similar approach going forward. In 2021, Italy also published a legally binding decree stating that reusable gowns – both Medical Devices or Devices for Individual Protection – should represent the first choice over single-use alternatives.


detailed analysis of carbon emissions at each stage of a gown’s lifecycle, comparing the environmental impacts of Elis reusable hospital gowns (standard and high protection) with a disposable alternative (standard and high protection). The comprehensive research9


analysed


19 impact categories, with reusable gowns performing better than disposable counterparts, showing that they have significant potential to reduce environmental emissions and deliver carbon savings over disposable alternatives. Overall, the global warming


potential (carbon footprint) of a reusable gown was found to be up to 69% lower than that of a disposable gown. It was also shown to generate just 16% to 22% of the mass of waste if used an optimal 75 times, with between 111g and 164g of waste saved for every reusable gown that is reprocessed. Depending on regional clinical waste disposal costs, this could potentially equate to annual savings of between £2,600 and £7,700, based on customers using 1,000 gowns per week. The results of the study


were calculated for 30 uses for all gowns as a base case, with 75 uses compared as a more realistic usage scenario. Moving from 30-75 uses resulted in a 10%-15% decrease in cumulative energy demand, a 20%-22% decrease in water consumption, and


a 12%-19% decrease in global warming potential, highlighting the importance of ensuring gowns remain in circulation until they have achieved an optimum number of uses. The savings when using a gown 75 times


compared to a disposable gown are 37%-66% for cumulative energy demand, 50%-61% for water consumption, 40%- 69% for global warming potential and 78%- 84% for waste generated. Variations on savings are based on factors such as the type of gown (standard performance vs high performance) and distribution distances travelled.


The case for change As this research unequivocally highlights, reusable surgical gowns offer a more sustainable alternative over disposable counterparts. On the one hand, there seems to be a real appetite for change, particularly with the NHS’s ambitious target to achieve a net zero health service by 2045. However, looking back over the last two decades, there are trends that will need to be dramatically reversed if this is to be achieved. The NHS is the largest user of disposable plastics in Europe, and creates 133,000 tonnes of plastic waste annually, with only 5% of it being recyclable.10


Until recently, many of


these disposable plastics have been regarded as necessary due to the fact they allow for easy maintenance of a sterile healthcare environment. With operating theatres estimated to account for one quarter of all hospital waste, this undoubtedly puts surgical procedures and the amount of waste they generate under the spotlight.


With concerns around sustainability and


the urgent need to reduce the reliance on single-use items, if the NHS is to achieve its zero carbon ambitions, it is essential that Trusts work together to adopt strategies that will eliminate the use of such products wherever possible and practical, but how can this best be achieved?


February 2023 I www.clinicalservicesjournal.com 39


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