The impact of switching from single-use to reusable healthcare products: a transparency checklist and systematic review of life-cycle assessments.

BACKGROUND: Replacing single-use products with reusable ones may reduce the environmental impact of healthcare. This study aimed to broadly assess the environmental effects of that substitution. METHODS: A systematic review of comparative cradle-to-grave life-cycle assessments (LCAs) of single-use and reusable healthcare products was conducted. The main outcomes assessed were changes in the environmental impact that resulted after switching from single-use to reusable products. As no standardized transparency checklist was available, one was developed here using DIN ISO 14040/14044. The final checklist included 22 criteria used to appraise the included studies. RESULTS: After screening, 27 studies were included in the analysis. The healthcare products were assigned to four categories: invasive medical devices, non-invasive medical devices, protection equipment and inhalers. The outcomes revealed a reduction in mean effect sizes for all environmental impacts except water use. Non-invasive medical devices have greater relative mitigation potential than invasive devices. On average, information on 64% of the transparency checklist items was reported. Gaps included the reporting of data quality requirements. CONCLUSIONS: Switching to reusable healthcare products is likely to reduce most impacts on the environment except water use, but the effect size differs among product categories. Possible study limitations include location bias, no systematic search of the grey literature and small samples for some impacts. This study's strengths are its approach to product categories and developed transparency catalogue. This catalogue could be useful to inform and guide a future process towards creating a standardized transparency checklist for the systematic reviews of LCAs.

Teaching life cycle assessment in higher education.

Purpose: Scientific Life Cycle Assessment (LCA) literature provides some examples of LCA teaching in higher education, but not a structured overview of LCA teaching contents and related competencies. Hence this paper aims at assessing and highlighting trends in LCA learning outcomes, teaching approaches and developed content used to equip graduates for their future professional practices in sustainability. Methods: Based on a literature review on teaching LCA in higher education and a collaborative consensus building approach through expert group panel discussions, an overview of LCA learning and competency levels with related teaching contents and corresponding workload is developed. The levels are built on the European Credit Transfer and Accumulation System (ECTS) and Bloom's taxonomy of learning. Results and discussion: The paper frames five LCA learning and competency levels that differ in terms of study program integration, workload, cognitive domain categories, learning outcomes, and envisioned professional skills. It furthermore provides insights into teaching approaches and content, including software use, related to these levels. Conclusions and recommendations: This paper encourages and supports higher educational bodies to implement a minimum of 'life cycle literacy' into students' curriculum across various domains by increasing the availability, visibility and quality of their teaching on life cycle thinking and LCA.