Reusable Surgical Head Covers Reduce Emissions, Environmental Impact

Reusable surgical head covers had a lower carbon footprint and a lower environmental impact than disposable ones, according to a life cycle assessment of three kinds of head covers in Amsterdam.

In metric tons, the mean carbon-equivalent footprint for an annual supply of head covers at a hospital with 25 operating rooms was 1.9 (95% CI 1.7-2.2) for disposable viscose covers, 1.7 (95% CI 1.6-1.8) for disposable polypropylene covers, and 0.7 (95% CI 0.6-0.9) for washable, reusable polyester covers (P<0.001), reported Nicolaas H. Sperna Weiland, MD, PhD, of the Centre for Sustainable Healthcare at Amsterdam University Medical Center, and colleagues.

For 16 of 17 secondary outcomes, including particulate matter formation, water ecotoxicity, and ozone depletion, reusable head covers had a lower environmental impact than their disposable counterparts, they noted in a research letter published in JAMA Surgery.

“We should just move away from the disposable items in surgery, but also in general and in healthcare,” co-author Eva Cohen, MD, also of Amsterdam University Medical Center, told MedPage Today. “It doesn’t have to be that hard to implement such a small thing, like a surgical cap, but it can get the conversation started about the whole transition towards decarbonizing healthcare in general.”

Healthcare is responsible for about 5.2% of all global greenhouse gas emissions, and the U.S. alone accounts for one quarter of this — more than any other nation, one assessment found.

A majority of healthcare emissions come from the supply chain, according to an analysis in Health Affairs, and the U.S. healthcare system has come to rely on the single-use medical devices that fuel these impacts.

“The primary driver is a perception that single-use disposables are safer than reusable devices,” the authors of that analysis wrote. “Despite broad adoption of single-use disposables, however, there is no compelling evidence that they reduce healthcare-acquired infections.”

Jodi Sherman, MD, of the Yale School of Medicine in New Haven, Connecticut, who was not involved with the study but did co-author the Health Affairs analysis, said that emissions from reusable caps, as opposed to disposable ones, come largely from their laundering. Because the European Union uses more clean energy than the U.S., “the same study performed in Europe would have a more favorable emissions result … compared to the United States.”

But despite this small difference, “I can tell you that every single study I’ve seen coming from the United States comparing reusable and disposables, has been, from a greenhouse gas perspective, more favorable for reusable,” she added.

What’s more, both Cohen and Sherman said, staff like wearing cloth surgical caps, even if they represent a small portion of medical equipment. “It’s things that staff really care about, which is why you’re seeing a paper on it, because staff like wearing their own hats,” Sherman said. “They can be colorful, they’re personal expression … and so they get annoyed when they have to wear these disposable caps or jackets.”

Sperna Weiland and team performed a life cycle assessment, a standard method in accordance with guidance from the International Organization for Standardization, to quantify and compare the carbon footprint and environmental impacts of two disposable head covers — the single-use non-woven viscose cover and the single-use non-woven polypropylene cover — and one washable reusable head cover.

They assessed an annual supply of head covers at a tertiary hospital, which uses 100,000 disposable head covers annually. Reusable head covers were certified by manufacturers for 100 reuses before disposal.

The reduction in carbon footprint from reusing head covers increased with the number of times they were reused. It took 16 to 19 uses of a cloth head cover to reach a lower carbon footprint than a disposable one, out of the 100 possible reuses.

Based on data in the Netherlands, “reusable head covers could be implemented as having neutral cost,” Sperna Weiland and colleagues wrote. “This is in line with the growing body of evidence that reusable products are cost-neutral or have a cost advantage (17%-94% lower costs).”

Detailed life cycle assessments of products, such as this one, “use local data derived directly from suppliers and are therefore specific to their situation, which can be a limitation,” the authors noted.

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