Reusable medical device: which LCA convinces a hospital buyer?

Since 22 August 2026, every new tender from a French public hospital must score at least one environmental criterion, in addition to price. For a manufacturer of reusable medical devices, whether instruments, operating theatre textiles or sterilisation containers, this is a chance to prove that the product outperforms single-use. The proof that holds up in front of a buyer is a comparative life cycle assessment (LCA), which relates the 2 options to the same use, washing and sterilisation included.

The tool above starts from what the result will be used for: a response to a tender, a sheet given to all customers and a published comparison do not call for the same review. The sections that follow start from the buyer's request and end with the file to prepare.

1What do hospital buyers ask for in 2026?

A public hospital buyer now scores bids on the environment, and the State is preparing a way to compare health products on their carbon footprint. These purchases weigh heavily in a hospital's carbon footprint assessment, where they count among the indirect emissions in its mandatory greenhouse gas emissions report (BEGES). The 2 developments converge on one question: how much does one use of your device emit, compared with the one it replaces?

The environmental criterion in public procurement

Article 35 of France's Climate and Resilience Act requires an environmental award criterion in public procurement, for any tender launched since 22 August 2026. The Legal Affairs Directorate of the French Ministry of the Economy considers that weighting the environment at at least 10% of the score may be a relevant practice. The details of the obligation are set out in our guide to responding to the environmental criterion of a public contract.

For a medical device, this criterion scores better when the bid states its footprint per use. Some buyers are already equipped for it. The "Medical devices" responsible procurement sheet, published in July 2024 by the Provence-Alpes-Côte d'Azur regional health agency (in French), asks buyers to compare single-use and reusable devices on total cost of ownership, sterilisation and disposal included. It also lists the criteria for the robustness of an LCA supplied by a bidder:

• It follows ISO 14040 and 14044 and covers the whole life cycle, from raw materials to end of life, including manufacturing, transport and use.
• It analyses several environmental impacts, including climate change, water consumption and mineral depletion, and not just carbon.
• It describes the data collection method clearly, so that the buyer can tell where each figure comes from and what it represents.
• It was carried out or reviewed by an external third party, that is, by someone who does not belong to the company selling the device.
• It leads to eco-design actions that reduce the measured impacts, a point the sheet also suggests scoring separately.

The carbon footprint method for medical devices

The health system ecological planning roadmap (in French), of December 2023, provided for a carbon footprint method for health products, starting with medicines and then medical devices. The method for medicines builds on Ecovamed, and some hospitals already score it, on a voluntary basis, in their tenders. For medical devices, the French Directorate General for Enterprise (DGE) put out for public consultation, from 3 August to 16 October 2026, a method specific to them.

The draft separates the roles, as the page reproduced below shows: in the tab that compares single-use and reusable devices, 4 data items are to be assessed by the healthcare facility, from the number of uses to maintenance. The manufacturer supplies the footprint of its reference, from manufacturing to end of life, and the tool calculates the footprint per use of the 2 options. The text recommends a gap of at least 20% to judge a difference significant, and defers the verification rules to a later date.

2Which LCA stands up in front of a buyer?

A comparative LCA follows ISO 14040 and 14044, which require systems to be compared on the same function, measured by the same functional unit. The rest of the study rests on this choice.

The functional unit: one use, one procedure, one year

The functional unit describes the service delivered, not the object. A US study of vaginal speculums, published in 2020, thus compared 20 gynaecological examinations, carried out either with plastic speculums discarded after use or with a steel speculum sterilised between 2 patients. At Nantes University Hospital, a 2025 study of electrosurgical scalpels used one year of use in the operating theatre, or 3,987 procedures.

The choice of unit carries with it the number of reuses, which becomes the most influential assumption of the study. The report must justify it and vary it in a sensitivity analysis.

The steps to count

The 2 systems do not have the same steps, and the standard requires them to be compared with equivalent boundaries. In the diagram below, what matters is the loop: each step it contains is counted as many times as the device is used, and its data sits with the hospital, not the manufacturer.

The critical review

ISO 14044 requires a review by a panel of at least 3 members, chaired by an independent expert, whenever a comparison between products is intended for the public. In that case it also prohibits combining the indicators into a single score after weighting. Such reviews remain rare in published studies: in a 2023 review of 27 LCAs of healthcare products, only 2 studies met the critical review criterion, even in part.

A study published in 2022 on Elis scrub suits shows what a reviewed comparison looks like. Commissioned and funded by the company, it was reviewed by a panel of 3 LCA experts. Its report shows both the climate gain, 31% fewer emissions over 4 years, and the increase in water consumption. Our article on the critical review of an LCA (in French) (in French) describes how a review proceeds.

3What do the published comparisons show?

The published studies lean clearly towards the reusable option. The University of Oxford systematic review, published in BMJ Open in December 2025, identified 47 direct comparisons: 39 conclude that the reusable option emits less, or 83%, often beyond a certain number of uses.

In the graphic below, each family is compared per use or per procedure. What to look at is the last line of each card: the condition that tips the result the other way.

What weighs on each side

The dominant items are not the same on each side. A review of studies on operating theatre equipment, published in 2021, shows that production accounts for a median of 88% of the footprint of a single-use item, and reprocessing for 68% of that of a reusable one. At Nantes University Hospital, 86% of the footprint of the reusable electrosurgical scalpels came from their sterilisation cycles.

For the manufacturer of a reusable device, manufacturing therefore most often weighs less than reprocessing. What decides the outcome happens at the hospital, in the sterilisation department. On the single-use side, disposal matters too: a soiled device goes into infectious healthcare waste, which is incinerated.

Cases where single-use comes out ahead

In the Oxford review, 6 comparisons favour single-use. Each has its own explanation, which lies in the country, the product or the study itself. Here are 3:

• In Denmark, in 2014, a disposable polyethylene bedpan emitted about 2 times less per use than a reusable bedpan, weighed down by its washing and disinfection. Incineration of the disposable one, with energy recovery, also worked in its favour.
• A reusable set for spinal surgery emitted more in a 2020 study funded by the manufacturer of the disposable set, which also included shorter operations with the disposable one.
• In a study published in 2023, a single-use flexible cystoscope emitted at least 33% less than the disinfection alone of a reusable cystoscope, a result its authors limit to the disinfection method studied.

4What tips a comparison?

A comparison tips mainly on 3 parameters, which the hospital knows better than the manufacturer: how it reprocesses the device, the electricity that powers its machines and the actual number of uses. A sound study tests them one by one in a sensitivity analysis and states the point from which the reusable option comes out ahead.

Reprocessing energy and machine loading

A 2022 study of sterilisation at an English public hospital modelled its washers and autoclaves, using a record of the machines' measured loading. In the graphic below, the reference bar is that hospital: everything that departs from it comes from the energy used for steam or from machine loading, never from the instrument itself. The same instrument, packed on its own rather than in a set, emits 2.8 times more per cycle, because a machine slot holds far fewer individually packed instruments than instruments arranged in a set.

These parameters also vary from one country to another. In France, an autoclave cycle generally lasts 18 minutes at 134 °C, according to the June 2025 Shift Project report on medical devices (in French). Other European countries commonly run cycles of 3 to 5 minutes. By keeping one of its autoclaves permanently switched off, the Dax hospital cut its sterilisation energy consumption by 38% in 2024.

Electricity and water

The electricity that powers reprocessing can reverse a conclusion. For the anaesthetic equipment of an Australian hospital with 6 operating theatres, a 2017 study found 9% more emissions when switching to reusable equipment with local electricity. With the electricity mix of the United Kingdom and Europe, the same switch reduced them by 84%. Low-carbon French electricity works in favour of the reusable option.

Water often works the other way, which a multi-criteria LCA brings out and a simple carbon footprint assessment does not see. In the same Australian study, water consumption more than doubled, and Elis's reusable scrub suits weigh about 20 times more than their disposable equivalents on the water resource indicator. Our guide to LCA indicators describes these impact categories.

The actual number of reuses

The tipping point is the number of uses beyond which the reusable device emits less. In the families presented above, it ranges from a few uses to around a hundred cycles. The number used in the study must therefore be the one customers observe, not the one stated in the instructions for use.

The responsible procurement sheet gives the buyer a way to check it: the number of devices in service, divided by the number repurchased each year, gives their real lifetime. At Nantes University Hospital, 78 reusable scalpels were in service with their cable, and 20 were repurchased in one year to replace losses and breakages. Their real lifetime is therefore about 4 years, or about 200 procedures each at the pace of the year's 3,987 procedures, according to our calculation.

5Who can carry out the LCA, and who can review it?

The study calls for 2 roles, which cannot be held by the same person. The LCA practitioner builds the model; the reviewer, or the panel, checks that it is sound and that the conclusions go no further than the results.

The LCA practitioner

A good practitioner knows medical device LCA and hospital reprocessing, and knows how to collect data from suppliers of materials and components. The questions to put to them before the quote cover this ground:

• Which sterilisation data will you use: records from a partner facility, or an average value taken from a foreign database?
• How will you model the loading of the washers and autoclaves, and will you test a low loading in a sensitivity analysis?
• Which single-use product will you compare against, and will the buyer be able to recognise the reference it buys today?
• Which indicators will you track beyond climate, in particular water, to respond to a buyer who asks for a multi-criteria analysis?

The reviewer and their independence

The reviewer has neither carried out the calculation nor chosen its assumptions. For a response to a tender, the standard requires nothing and an external expert meets the buyer's criterion; for a published comparison, the panel is mandatory.

A review by a single expert costs, as an order of magnitude observed in 2026, between €3,000 and €5,000 excl. VAT, with no public price list. The price of an LCA varies more widely. Diag Éco-conception, an eco-design diagnostic run by Bpifrance (the French public investment bank) and ADEME (the French Agency for Ecological Transition), which includes a streamlined LCA, leaves €5,400 excl. VAT to be paid by a company with fewer than 50 employees. Under 250 employees, this remaining cost rises to €7,200 excl. VAT. Our guide to transition funding lists the other sources of funding.

Warning signs

Before signing and after receiving the study, 3 warning signs are reasons to hesitate:

• The quote promises to "certify" or "validate" that the reusable device is better, whereas the LCA may conclude the opposite and such a sentence becomes a claim that must be substantiated.
• The study reuses a percentage taken from a literature review instead of modelling the actual device and its reprocessing.
• The report gives neither a tipping point nor a sensitivity analysis on the number of uses, the energy of sterilisation or the electricity.

6What to prepare before launching the study?

An LCA of a reusable device moves at the pace of the hospital data. The manufacturer saves weeks by gathering the following items before the study starts:

• The device's bill of materials, with the mass and nature of each material, the place of manufacture and the delivery packaging.
• The number of cycles observed at customers, taken from sterilisation traceability records or from repurchases, and not only the number stated in the instructions for use.
• The reprocessing protocol from the instructions for use: pre-disinfection, washing, packing, type of sterilisation and number of devices per basket.
• The electricity, water and steam consumption of the washers and autoclaves of at least one partner facility, with the actual loading of the batches.
• The competing single-use reference, its weight, its packaging and its disposal route, ideally purchased and weighed.

The partner facility matters as much as the consultancy. A sterilisation department that opens its records gives the study the data that the buyer challenges least, since it comes from the buyer's own line of work. The eco-design practices that follow, such as lightening the sterilisation packaging or making the device easier to load, are then measured with the same model. Packaging also falls under the European rules on packaging for medical devices.

For us at Projet Celsius, the question that decides an LCA of a reusable device is the number of cycles. A number taken from the instructions for use does not stand up to a buyer who tracks repurchases. We recommend measuring this number at 2 or 3 customers, publishing the tipping point with the comparison, and having the study reviewed before any commercial use.

7Key takeaways

• Since 22 August 2026, every new tender from a French public hospital scores at least one environmental criterion, and the buyer can compare devices per use.
• The proof that holds up is a comparative LCA under ISO 14040 and 14044, which counts washing, packaging and sterilisation at every cycle.
• Published comparisons favour the reusable option in 39 cases out of 47, but not when reuses are few or the electricity is very carbon-intensive.
• The number of cycles used must be the one customers observe, and the tipping point must appear in the report.
• A comparison intended for the public requires a critical review by a panel of at least 3 members, and prohibits combining the indicators into a weighted score.

To place medical devices within the footprint of the healthcare system, see our guide to the carbon footprint of medical devices.

Further resources

Frequently asked questions

1Does a reusable medical device emit less CO2 than a single-use one?

Most often, yes. Of 47 direct comparisons identified by a University of Oxford review published in December 2025, 39 favour the reusable option, often beyond a certain number of uses. Single-use can come out ahead when the device is used only a few times, when its reprocessing consumes a lot of energy or when the electricity is very carbon-intensive.

2Which standard should be followed to compare a reusable and a single-use medical device?

The ISO 14040 and 14044 standards for life cycle assessment. They require the 2 options to be compared on the same function, for example one use or one procedure, with equivalent boundaries: for the reusable device, washing, packaging and sterilisation are counted at every cycle. If the comparison is made public, a critical review by a panel is mandatory.

3Is a critical review mandatory to respond to a hospital tender?

No. ISO 14044 requires it only for a comparison intended for the public, with a panel of at least 3 members. A buyer may nonetheless expect a study carried out or reviewed by an external third party, a criterion listed in the responsible procurement sheet on medical devices from the Provence-Alpes-Côte d'Azur regional health agency (ARS). A review of the study by an independent expert meets that expectation.

4How many times does a device need to be reused to emit less than the disposable one?

It depends on the device and its reprocessing. For laparoscopic instruments studied in the United Kingdom, the reusable option comes out ahead as soon as its components are used more than 2 times; for a sterilisation container studied in the Netherlands, after 98 cycles. A sound LCA calculates this tipping point and compares it with the number of uses observed at customers.

5What is the DGE method for the carbon footprint of medical devices?

It is a draft simplified method, put out for public consultation from 3 August to 16 October 2026 by France's Directorate General for Enterprise (DGE). The manufacturer declares the footprint of its reference; the healthcare facility assesses the number of uses, washing, sterilisation and maintenance, and the matrix calculates the footprint per use of the single-use and reusable options. The verification rules will be specified later.

6Can a single-use medical device be reprocessed in France?

In principle no: the French Public Health Code prohibits placing reprocessed single-use devices on the market and using them. A 2-year trial, opened on 1 January 2026, is an exception for certain cardiology and angiography catheters, in 10 facilities designated by a ministerial order of 22 July 2026. A reusable device, designed to be cleaned and sterilised, falls outside this rule.

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