The long road towards repair of medical instruments

Hospitals discard a large pile of waste every single day. Government intervention, and a simplified legal infrastructure are needed to make the transition towards circularity. And even then, according to Bart van Straten of Van Straten Medical, it takes guts and a lot of perseverance to establish circularity for medical instruments. 

As a researcher, Van Straten was involved in various Medical Delta research projects. As a business owner, he is one of the submitters of research questions for the Thesis Lab Sustainable Healthcare of LDE and Medical Delta, the third edition of which will start early next year. He is therefore a driver for research into the greening of healthcare within Medical Delta.

Not only does every patient require numerous blue plastic sheets each day, there also is a lot of packaging material and wrapping paper involved. Even the stainless-steel instruments used during surgery, as well as more complex medical devices such as catheters or staplers, are used only for a single procedure and then discarded.

"Forty years ago, most of the complex surgical instruments were reusable’, says Bart van Straten. ‘But as technology progressed and the complexity of instruments increased, a linear economic expansion based on mass consumption and maximisation of manufacturing volumes evolved. This is the direct opposite of a sustainable and circular model where products and materials remain in the system."

Adopting a circular business model

Since 1997, Van Straten has worked as a general manager for Van Straten Medical, the family business that produces, repairs, and refurbishes surgical and medical instruments. In 2011, the company made the bold step to start the transition towards a circular business model, including repair, maintenance, sterilisation, and transport of medical instruments. "It is our goal to make the healthcare sector more sustainable," he says.

It is our goal to make the healthcare sector more sustainableVan Straten strongly believes that the 2050 climate goals our society has agreed on can only be achieved by translating them into concrete projects. "As a medium-sized company operating from Utrecht, we are more flexible in making changes to our business operations than big corporations. Still, it was quite a gamble for us as well, and we still need our linear sales volumes to finance the transition to becoming fully circular."

Reconditioning medical instruments

As an example, Van Straten refers to a blue-and-white device with a large snout: a medical stapler used during operations. "These machines are discarded after every surgical procedure," he says. "The problem for most hospitals is the unavailability of reusable alternatives. Producers and suppliers shifted from reusable devices to single-use devices for numerous of reasons. And whenever reusable devices are used, many hospitals don’t even think about having these repaired simply because it is not in their system to do so. Legislation in many countries also requires specific hospital waste to be incinerated. That is another reason why many hospitals do not focus on repair but rather replace their devices with new ones even if they only have minor defects."

Disposing large volumes of high value medical devices doesn’t make sense – from an economic perspective, and even less so when considering that the scarcity of raw materials is driving up the prices and delivery times of these devices. "If we are to reach the sustainability goals, the healthcare sector really needs to take responsibility and deal more sustainably with the consumption and production of medical devices."

Hospitals can profit

In 2021, Van Straten co-authored the study titled ‘A Circular Healthcare Economy’, in which it was estimated that hospitals could save tens of thousands of euros each year by adopting a more circular approach towards disposed surgical instruments and stainless-steel waste – such as disposed transport carts, instrument sets, and other equipment.

Dutch Legislation requires much hospital waste to be incinerated, even when it contains valuable materialsEach year, large hospitals use over 100,000 reusable instruments and up that number of disposable instruments. These vary from scissors that have become blunt to €3,000 endoscopes of which only a tip is damaged. Having these repaired reduces both costs and the environmental impact of hospitals. Van Straten: "These savings can relatively easily be realized by replacing disposable instruments with reusable ones, and by setting up a repair and preventive maintenance program."