title: A life cycle assessment of reusable and single-use central venous catheter insertion kits.
abstract: BACKGROUND
  For most items used in operating rooms, it is unclear whether reusable items are environmentally and financially advantageous in comparison with single-use variants. We examined the life cycles of reusable and single-use central venous catheter kits used to aid the insertion of single-use, central venous catheters in operating rooms. We did not examine the actual disposable catheter sets themselves. We assessed the entire financial and environmental costs for the kits, including the influence of the energy source used for sterilization.
  
  
  METHODS
  For the reusable central venous catheter kit, we performed a "time-in-motion" study to determine the labor costs and measured the energy and water consumption for cleaning and sterilization at Western Health, Melbourne, Australia. For the majority of the inputs for the single-use kit, we relied upon industry and inventory-sourced databases. We modeled the life cycles of the reusable and single-use central venous catheter kits with Monte Carlo analysis.
  
  
  RESULTS
  Inclusive of labor, the reusable central venous catheter insertion kits cost $6.35 Australian ($A) (95% confidence interval [CI], $A5.89 to $A6.86), and the single-use kits cost $A8.65. For the reusable kit, CO(2) emissions were 1211 g (95% CI, 1099 to 1323 g) and for the single-use kit 407 g (95% CI, 379 to 442 g). Water use was 27.7 L (95% CI, 27.0 to 28.6 l) for the reusable kit and 2.5 L (95% CI, 2.1 to 2.9 l) for the single-use kit. For the reusable kit, sterilization had the greatest environmental cost, and for the single-use kit, the manufacture of plastic and metal components had the largest environmental costs. Different sources of electricity to make the reusable kits patient-ready again affected the CO(2) emissions: electricity from hospital gas cogeneration resulted in 436 g CO(2) (95% CI, 410 to 473 g CO(2)), from the United States electricity grid 764 g CO(2) (95% CI, 509 to 1174 g CO(2)), and from the European electricity grid 572 g (95% CI, 470 to 713 g CO(2)).
  
  
  CONCLUSIONS
  Inclusive of labor, the reusable central venous catheter insertion kits were less expensive than were the single-use kits. For our hospital, which uses brown coal-sourced electricity, the environmental costs of the reusable kit were considerably greater than those of the single-use kit. Efforts to reduce the environmental footprint of reusable items should be directed towards decreasing the water and energy consumed in cleaning and sterilization. The source of hospital electricity significantly alters the relative environmental effects of reusable items.
authors.affiliation: Department of Anaesthesia, Western Health, Melbourne, Victoria, Australia. forbes.mcgain@wh.org.au
authors.forename: Forbes
authors.initials: F
authors.lastname: McGain
authors.forename: Scott
authors.initials: S
authors.lastname: McAlister
authors.forename: Andrew
authors.initials: A
authors.lastname: McGavin
authors.forename: David
authors.initials: D
authors.lastname: Story
mesh_terms: D002245:Carbon Dioxide / Q000032:analysis; D002405:Catheterization, Central Venous / Q000191:economics / Q000295:instrumentation*; D057785:Catheters / Q000191:economics / Q000706:statistics & numerical data*; D003198:Computer Simulation; D003246:Conservation of Energy Resources / Q000191:economics / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D004209:Disposable Equipment / Q000191:economics / Q000706:statistics & numerical data*; D004560:Electricity; D004787:Environmental Pollution / Q000032:analysis; D017743:Equipment Reuse / Q000191:economics / Q000706:statistics & numerical data*; D008506:Medical Waste; D015233:Models, Statistical; D009010:Monte Carlo Method; D013193:Stainless Steel; D013242:Sterilization / Q000191:economics / Q000706:statistics & numerical data; D014739:Victoria; D014867:Water; D014877:Water Pollution, Chemical / Q000032:analysis
chemical_list: D008506:Medical Waste; D014867:Water; D013193:Stainless Steel; D002245:Carbon Dioxide