The environmental footprint of single-use versus reusable cloths for clinical surface decontamination: a life cycle approach

Published:September 14, 2022DOI:



      Global sustainability is a major health concern facing our planet today. The healthcare sector is a significant contributor to environmentally damaging activity. Reusable cloths should be considered as an environmentally friendly alternative to the predominantly used single-use surface wipes in cleaning and disinfection of environmental surfaces in healthcare settings.


      To conduct a rapid review of current policies on surface decontamination in healthcare settings; then to carry out a life cycle impact assessment (LCIA) of reusable cotton and microfibre cloths versus conventional single-use cloths, with three compatible disinfectants.


      Seven countries were included in the rapid review of policies. For the LCIA, inputs, outputs, and processes across the life cycle were included, using EcoInvent database v3.7.1 and open LCIA software. Sixteen European-recommended environmental impact categories and eight human health categories were considered.


      Infection prevention policies examined do not require single-use wipes for cleaning and disinfection. The disinfectant with the highest environmental impact was isopropyl alcohol. The most environmentally sustainable option for clinical surface decontamination was the microfibre cloth when used with a quaternary ammonium compound. The least environmentally sustainable option was cotton with isopropyl alcohol.


      Impacts were primarily attributed with the use of the disinfectant agent and travel processes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dahlgren G.
        • Whitehead M.
        • Institute for Futures Studies
        Policies and strategies to promote social equity in health. Background document to WHO – Strategy paper for Europe.
        Arbetsrapport. 2007; 14
        • Whitmee S.
        • Haines A.
        • Beyrer C.
        • Boltz F.
        • Capon A.G.
        • de Souza Dias B.F.
        • et al.
        Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health.
        Lancet. 2015; 386 ([Erratum in: Lancet 2015;386(10007):1944.]): 1973-2028
        • Lyne A.
        • Ashley P.
        • Saget S.
        • Porto Costa M.
        • Underwood B.
        • Duane B.
        Combining evidence-based healthcare with environmental sustainability: using the toothbrush as a model.
        Br Dent J. 2020; 229: 303-309
        • McMichael A.J.
        • Campbell-Lendrum D.H.
        • Corvalán C.F.
        • Ebi K.L.
        • Githeko A.K.
        • Scheraga J.D.
        • et al.
        How much disease could climate change cause?.
        in: McMichael A.J. Campbell-Lendrum D.H. Corvalan C.F. Climate change and human health: risks and responses. WHO, Geneva2003
        • Tennison I.
        • Roschnik S.
        • Ashby B.
        • Boyd R.
        • Hamilton I.
        • Oreszczyn T.
        • et al.
        Health care’s response to climate change: a carbon footprint assessment of the NHS in England.
        Lancet Planetary Health. 2021; 5: e84-e92
        • Pichler P.P.
        • Jaccard I.S.
        • Weisz U.
        • Weisz H.
        International comparison of health care carbon footprints.
        Environ Res Lett. 2019; 14064004
        • Mulimani P.
        Green dentistry: the art and science of sustainable practice.
        BDJ. 2017; 222: 954-961
        • Borglin L.
        • Pekarski S.
        • Saget S.
        • Duane B.
        The life cycle analysis of a dental examination: quantifying the environmental burden of an examination in a hypothetical dental practice.
        Community Dent Oral Epidemiol. 2021; 49: 581-593
        • Wise J.
        Climate emergency: new expert panel will set out how NHS can achieve net zero.
        BMJ. 2020; 368: m310
        • Boyce J.M.
        A review of wipes used to disinfect hard surfaces in health care facilities.
        Am J Infect Control. 2021; 49: 104-114
        • Duane B.
        • Taylor T.
        • Tahl-Timmins W.
        • Hyland J.
        • Mackie P.
        • Pollard A.
        Carbon mitigation, patient choice and cost reduction – triple bottom line optimisation for health care planning.
        Public Health. 2014; 128: 920-924
        • Maris P.
        Modes of action of disinfectants.
        Rev Sci Tech. 1995; 14: 47
        • Song X.
        • Vossebein L.
        • Zille A.
        Efficacy of disinfectant-impregnated wipes used for surface disinfection in hospitals: a review.
        Antimicrob Resist Infect Control. 2019; 8: 139
        • Mohapatra S.
        Sterilization and disinfection.
        Essent Neuroanesth. 2017; : 929-944
        • Klemeš J.J.
        • Fan Y.V.
        • Jiang P.
        The energy and environmental footprints of COVID-19 fighting measures – PPE, disinfection, supply chains.
        Energy (Oxf). 2020; 211118701
        • Rizan C.
        • Bhutta M.F.
        • Reed M.
        • Lillywhite R.
        The carbon footprint of waste streams in a UK hospital.
        J Cleaner Prodn. 2021; 286: 125446
        • Duane B.
        • Crotty J.
        • Wilmott S.
        Embracing sustainable dentistry.
        Springer Nature, Dublin2022: 183-184
        • European Environmental Agency
        Average CO2 emissions from new cars and new vans increased in 2018.
        European Environmental Agency, 2019 (Available at:) ([last accessed January 2022])
        • Sherman J.D.
        • Raibley L.A.
        • Eckelman M.J.
        Life cycle assessment and costing methods for device procurement: comparing reusable and single-use disposable laryngoscopes.
        Anesth Analg. 2018; 127: 434-443
        • Rizan C.
        • Bhutta M.F.
        Environmental impact and life cycle financial cost of hybrid (reusable/single-use) instruments versus single-use equivalents in laparoscopic cholecystectomy.
        Surg Endosc. 2022; 36: 4067-4078
        • Vozzola E.
        • Overcash M.
        • Griffing E.
        An environmental analysis of reusable and disposable surgical gowns.
        AORN J. 2020; 111: 315-325
        • Vozzola E.
        • Overcash M.
        • Griffing E.
        Environmental considerations in the selection of isolation gowns: a life cycle assessment of reusable and disposable alternatives.
        Am J Infect Control. 2018; 46: 881-886
        • Canadian Dental Association
        Infection prevention and control in the dental office.
        2006 (Available at:) ([last accessed January 2022])
        • Republic of Ireland Dental Council
        Code of Practice relating to infection prevention and control.
        2015 (Available at:) ([last accessed January 2022])
        • New Zealand Dental Council
        Infection prevention and control practice standard.
        2015 (Available at:) ([last accessed January 2022])
      1. Scottish dental clinical effectiveness programme (SDCEP). 2018 (Available at:) ([last accessed January 2022])
        • UK National Health Service (NHS)
        Infection prevention and control policies and procedures.
        2018 (Available at:) ([last accessed January 2022])
        • Centers for Disease Control and Prevention
        American Dental Association summary of infection prevention practices in dental settings.
        in: Guideline for disinfection and sterilization in healthcare facilities. 2019 (Available at:) ([last accessed January 2022])
        • Australian Dental Association
        Guidelines for infection prevention and control.
        2021 (Available at:) ([last accessed January 2022])
        • Rutala W.A.
        • Weber D.J.
        Monitoring and improving the effectiveness of surface cleaning and disinfection.
        Am J Infect Control. 2016; 44: e69-e76
      2. Eurow. Microfiber towels production process. n.d. Available at: [last accessed January 2022].

      3. Microfibre cloth. Available at:[last accessed January 2022].

      4. Google Maps. Available at:,-95.677068,2z [last accessed January 2022].

      5. Sea Rates. Available at:[last accessed January 2022].

        • Diab-Elschahawi M.
        • Assadian O.
        • Blacky A.
        • Stadler M.
        • Pernicka E.
        • Berger J.
        • et al.
        Evaluation of the decontamination efficacy of new and reprocessed microfiber cleaning cloth compared with other commonly used cleaning cloths in the hospital.
        Am J Infect Control. 2010; 38: 289-292
        • Wesgate R.
        • Robertson A.
        • Barrell M.
        • Teska P.
        • Maillard J.Y.
        Impact of test protocols and material binding on the efficacy of antimicrobial wipes.
        J Hosp Infect. 2019; 103: e25-e32
        • Brewer C.
        • Streel E.
        Is alcohol in hand sanitizers absorbed through the skin or lungs? Implications for disulfiram treatment.
        Alcohol Alcohol. 2020; 55: 354-356
        • Institute for Environment and Sustainability
        International Life Cycle Data System (ILCD) handbook: recommendations for life cycle impact assessment in the European context.
        1st edn. European Commission Joint Research Centre, 2011 (Available at: ILCD handbook – general guide on LCA – detailed guidance (
        • International Organisation for Standardisation (Switzerland)
        Environmental management: life cycle assessment requirements and guidelines.
        2006 (Available at:) ([last accessed September 2022])
        • NHS England
        Telemedicine pilot.
        2020 (Available at:) ([last accessed September 2022])
        • Wang D.M.
        Environmental protection in clothing industry.
        2015 international conference on sustainable development, New York City, USA, September 23rd–24th,. 2015; (p. 729–35)
        • World Wildlife Fund
        Living waters conserving the source of life.
        2002 (Available at:) ([last accessed February 2022])
        • Bhatia S.C.
        • Devraj S.
        Pollution control in textile industry.
        WPI Publishing, New Delhi2017
        • Foo K.Y.
        • Hameed B.H.
        Decontamination of textile wastewater via TiO2/activated carbon composite materials.
        Adv Colloid Interface Sci. 2010; 159: 130-143
      6. United Nations World Water Assessment Programme. United nations world water development report 2015: water for a sustainable world. Paris: UNESCO.

        • UNESCO–Institute for Water Education
        The water footprint of cotton consumption.
        UNESCO, Delft2005: 1-44
        • Abedin M.A.
        • Collins A.E.
        • Habiba U.
        • Shaw R.
        Climate change, water scarcity, and health adaptation in southwestern coastal Bangladesh.
        Int J Disaster Risk Sci. 2019; 10: 28-42
        • Shrivastava P.
        • Kumar R.
        Soil salinity: a serious environmental issue and plant growth promoting bacteria as one of the tools for its alleviation.
        Saudi J Biol Sci. 2015; 22: 123-131
        • Gago J.
        • Carretero O.
        • Filgueiras A.V.
        • Viñas L.
        Synthetic microfibers in the marine environment: a review on their occurrence in seawater and sediments.
        Mar Pollut Bull. 2018; 127: 365-376
        • Karbalaei S.
        • Hanachi P.
        • Walker T.R.
        • Cole M.
        Occurrence, sources, human health impacts and mitigation of microplastic pollution.
        Environ Sci Pollut Res Int. 2018; 25: 36046-36063
        • DeWit W.
        • Towers E.
        • Guinchard J.
        • Ahmed N.
        Plastics: the costs to society, the environment and the economy.
        2021 (Available at:) ([last accessed February 2022])
        • McIlwraith H.K.
        • Lin J.
        • Erdle L.M.
        • Mallos N.
        • Diamond M.L.
        • Rochman C.M.
        Capturing microfibers – marketed technologies reduce microfiber emissions from washing machines.
        Mar Pollut Bull. 2019; 139: 40-45
        • Lant N.J.
        • Hayward A.S.
        • Peththawadu M.M.D.
        • Sheridan K.J.
        • Dean J.R.
        Microfiber release from real soiled consumer laundry and the impact of fabric care products and washing conditions.
        PLoS One. 2020; 15e0233332
        • Talvitie J.
        • Mikola A.
        • Setälä O.
        • Heinonen M.
        • Koistinen A.
        How well is microlitter purified from wastewater? – A detailed study on the stepwise removal of microlitter in a tertiary level wastewater treatment plant.
        Water Res. 2017; 109: 164-172
        • Ritchie H.
        • Roser M.
        (2020. Available at:) ([last accessed February 2022])
        • Manfredi S.
        • Tonini D.
        • Christensen T.H.
        • Scharff H.
        Landfilling of waste: accounting of greenhouse gases and global warming contributions.
        Waste Manag Res. 2009; 27: 825-836
        • Haslinger S.
        • Wang Y.
        • Rissanen M.
        • Lossa M.B.
        • Tanttu M.
        • Ilen E.
        Recycling of vat and reactive dyed textile waste to new colored man-made cellulose fibers.
        Green Chem. 2019; 21: 5598-5610
        • Trajtman A.N.
        • Manickam K.
        • Alfa M.J.
        Microfiber cloths reduce the transfer of Clostridium difficile spores to environmental surfaces compared with cotton cloths.
        Am J Infect Control. 2015; 43: 686-689
        • McQuerry M.
        • Easter E.
        • Cao A.
        Disposable versus reusable medical gowns: a performance comparison.
        Am J Infect Control. 2021; 49: 563-570
        • McDowell J.W.
        An environmental, economic and health comparison of single-use and reusable drapes and gowns.
        Asepsis. 1993; 13: 1-15
      7. European Commission. EU climate action. Available at: [last accessed February 2022].