How Orthopedics Could Lead the Way Toward Healthcare Joining the Circular Economy

Healthcare is one of the largest and most rapidly expanding sectors of the global economy, delivering better products and services to cure diseases and treat people. It also produces massive amounts of trash and greenhouse gas emissions. If we are to meet global targets to reduce greenhouse gas emissions, the health sector is going to need to move from its current pattern of using products once and throwing them away to a more circular economy model. The field of orthopedic medicine is no exception.

The U.S. healthcare industry sector generates 5.9 million tons of garbage annually and 8% of the nation’s total carbon dioxide emissions. In addition, a 2% to 3% increase in healthcare waste is anticipated as a result of a rise in the population index and the expansion of healthcare facilities. This growth in healthcare waste can have significant effects on environmental sustainability and public health.¹

Healthcare waste is a serious environmental problem that requires deliberate management and action to prevent its adverse effects. Globally, incineration is viewed as a solution to this problem, as it reduces the volume of medical waste and eliminates biohazardous components. The incineration process, however, creates nitrous oxide and several carcinogens, such as polychlorinated biphenyls, furans, and dioxins. Exposure to these can cause harm to fetal and adult bodily function as well as acidification of land and oceans.² Therefore, incineration is not the solution to the problem of large quantities of healthcare waste. Further research reveals roughly 90% of the medical industry’s overall waste is created by single-use products.²

A survey of four Mayo Clinic locations in the U.S. revealed at least 20% of medical waste generated in the nation’s hospitals comprised of single-use plastics. These numbers demonstrate that the usage of single-use medical equipment is a significant factor in the rise of medical waste, and therefore, one of the most pressing challenges at hand. In addition, there is a lack of laws in many nations regarding manufacturing procedures, labeling standards, disposal limits, and the creation of guidelines for end-of-life management and recycling. Consequently, it is vital to study techniques for reducing the quantity of healthcare waste generated.

While providing quality treatment is of the utmost importance, reducing healthcare waste by reprocessing, recycling, and implementing more sustainable procedures may save patients, environmental and financial resources, and even prevent individuals from visiting hospitals.^3,4 A holistic strategy is needed to investigate the many opportunities for integrating sustainability into the medical business without jeopardizing patient safety.

Understanding the Circular Economy and Why It’s Important

Several governments and industry practitioners are promoting the notion of circular economy (CE) as a possible approach to address the unique and complex difficulties required to make the health sector healthier for patients and the planet—while also offering a viable revenue opportunity for industrial businesses. Change is likely to happen faster when businesses can prosper from the process.

The circular economy is centered on reusing, recycling, and recovering as much raw material as possible throughout a product’s lifespan, from manufacturing to distribution to consumption. The circular economy seeks to remove the inefficiencies of a linear model based solely on take, make, and waste. To achieve this objective, the circular economy is based on three fundamental principles: decreasing waste and pollution, prolonging the use of products and materials, and restoring natural systems.⁵

The circular economy is not simply a strategy for better or more suitable waste management. The 3Rs (reduce, reuse, and recycle) principle, which is commonly used to summarize the circular economy only provides a partial picture of what it is, as its application extends much beyond waste treatment and includes product and process design.⁶

While the conventional approach of design for sustainability aims to reduce pollution and the carbon footprint left by products by making small improvements to the product such as the use of clean energy during production or the sourcing of raw materials sustainably, the circular economy approach addresses the environmental harm caused by the extraction, use, and subsequent disposal of new materials, as well as the loss of raw material value.

The Waste Management Hierarchy: A Closer Look

When addressing healthcare waste through the lens of the circular economy, the suitable recovery method for the product is based on its value and criticality. Here, value is defined as the economic value of a fully functional product and criticality is the risk of infection from the use of uncleaned product. For products that have high value and high criticality, reprocessing is the best recovery method (Figure 1).

Making It Safe

Reprocessing of medical devices labeled by manufacturers for single-use is allowed on a case-by-case basis in the United States, Canada, Germany, the United Kingdom and about 20 other countries, according to the Association of Medical Device Reprocessors (AMDR). In these countries, strict regulatory protocols are required where regulatory authorities review reprocessing conducted in commercial facilities to ensure the devices are as safe and effective as their virgin counterparts. Not every device can be reprocessed, and the number of uses, or “turns,” is determined by the regulatory authority in its review process. Over 20 years ago, the United States was the first country to allow commercial reprocessing, and no increased risk to patient safety has ever been found, according to the Association of Medical Device Reprocessors.

Orthopedic Medicine and the Circular Economy

Devices reprocessed range from external devices such as blood pressure cuffs and pulse oximeter cables to invasive devices such as ablation wands, arthroscopic shavers and trocars, and numerous blades commonly used in orthopedic procedures. Thousands of these devices are already being collected, reprocessed, and reused. But according to AMDR, only a small percent of what can be reprocessed is being collected. Further, devices could be designed for reuse. But according to the reprocessing association, many of these devices are intentionally designed with built in obsolescence. The orthopedic field has the opportunity to drive the circular economy by demanding manufacturers design with the intent to reuse. While loss of revenue by original equipment manufacturers may seem like an obstacle, several manufacturers—including Arjo, Stryker, Medline, and Cardinal—have created sustainability-focused reprocessing divisions so they profit from making the original device while also benefiting from reprocessing.

Why Sustainable Practices Can Be Profitable

Despite the fact many medical devices are intended for single use, healthcare facilities around the world rely on reprocessed equipment to save money. According to published data, in the United States, over 10,000 hospitals partner with commercial reprocessors to reuse at least some single-use devices.⁷ Commercial reprocessing companies examine, refurbish, disinfect/sterilize, inspect, and repackage this equipment, saving hospitals over $437 million in 2021 alone.⁸

We Need to Adjust our Mindset

A case study examining the possibilities of implementing circular economy in the single-use medical device market determined manufacturers lack the proper mindset, internal processes, and product to move to a circular business model. The primary internal obstacles for this transition from a linear to a circular business model will be 1) the current single-use mentality and emphasis on low cost; 2) resistance to changing existing processes; 3) the complexity of incorporating circular practices; and 4) the difficulty of developing a validated reusable device.⁸

Single-use medical device manufacturers—including those in the orthopedic space—must therefore primarily focus on internal enablers such as 1) shifting the company’s goal and mindset toward developing circular devices and valuing sustainability; 2) educating employees on CE; 3) incorporating circular product design strategies and measurable indicators of circularity during the development stage; 4) conducting small pilot projects; and 5) developing a standardized re-sterilization process.⁹

Our Moral Responsibility

If we look at the issues of healthcare waste and medical device reprocessing from a moral perspective, we realize it is the responsibility of the medical industry to provide effective, as well as affordable, healthcare to the people. Moreover, it is their responsibility to ensure their practices don’t lead to more patients going to the hospital. The decision to choose a sustainable option cannot be left on the patients or their relatives; instead, the aim should be to make most devices reprocessable to reduce their environmental impact and, more importantly, treat more patients and lower healthcare-associated costs, which is the duty of the healthcare industry.

References

1. bit.ly/odt230131
2. bit.ly/odt230132
3. bbc.in/3QGyBSN
4. bit.ly/odt230134
5. bit.ly/odt230135
6. bit.ly/odt230136a
7. bit.ly/odt230136
8. bit.ly/odt230137
9. bit.ly/odt230138

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Akshat Jain is a mechanical engineer turned product designer focused on sustainable design strategies. He received his Master of Science degree in Integrated Product Design, Innovation Management and Product Development from Sweden’s KTH Royal Institute of Technology in 2022.