Abstract
OBJECTIVE: Medical devices account for approximately 6-10% of national health systems' carbon footprints. The global use of single-use devices has increased, with implications for health systems' climate impact. This systematic review aimed to synthesise global evidence on medical device carbon footprints, compare single-use and reusable devices and identify lifecycle carbon hotspots to inform policy and practice. DESIGN: We conducted a systematic review of carbon footprints of medical devices used in clinical settings, reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. DATA SOURCES: We searched MEDLINE and Scopus, in 2022 and updated in 2025, and used citation tracking. ELIGIBILITY CRITERIA: English-language, primary research involving carbon modelling of medical devices used in clinical settings was included, with no date restrictions. DATA EXTRACTION AND SYNTHESIS: Articles were screened, and data on carbon modelling methods, device footprints and lifecycle hotspots were extracted by two independent reviewers. Findings were synthesised in figures and tables, and narratively in text. The heterogeneity in carbon modelling approaches prevented quantitative synthesis. RESULTS: Of 5195 articles identified, 59 met inclusion criteria. Life cycle assessment was the main carbon modelling approach, though application and data quality varied. Carbon footprints of 61 devices were assessed, primarily in surgical (16), anaesthetic (8) and endoscopic (8) specialties. Reusable devices consistently had lower lifecycle footprints. Hotspots were production and manufacturing for single-use devices and reprocessing for reusables. CONCLUSION: Reusable devices are preferable from a climate perspective, though efforts are needed to reduce reprocessing emissions. Co-ordinated interventions are required: policymakers can enable supportive regulation; manufacturers can improve device design; healthcare facilities can optimise reprocessing; and providers can prioritise reusable device procurement and use.