# Environmental Efficiency Indices in the Public Hospital Sector: A Proposal
## 2 Methodology
### Methodology
#### 2.2.4 Impact Calculation and Assessment  
Finally, in the fourth phase of the study, the calculation of the environmental impacts was made. The software chosen to perform the study was SimaPro v.9.1(r). This is a professional tool that allows the calculation of the environmental, social, and economic impacts associated with a product throughout its entire life cycle.  
Firstly, the global impact of hospital activities was calculated using the ReCiPe method. This is one of the most used methods in the LCA research area, and includes both the midpoint and the endpoint method. The \"midpoint\" and the \"endpoint\" are especially different links in the causal chain with an impact on the results of the analysis of life cycle  
\begin{table}
\begin{tabular}{c c} \hline \hline
**Waste Production** & **Item** \\ \hline \hline \multicolumn{3}{c}{Organic waste} \\ \multicolumn{3}{c}{Glass} \\ \multicolumn{3}{c}{Cardboard} \\ \multicolumn{3}{c}{Paper} \\ \multicolumn{3}{c}{Debris/wood/metal} \\ \hline \hline
**Group II—Non-specific healthcare wastes** & \\ \hline \hline
**Group III—Biohazardous healthcare wastes** & Hospital waste \\ \hline \hline \multicolumn{3}{c}{Expired drugs} \\ \multicolumn{3}{c}{Halogenated solvents} \\ \multicolumn{3}{c}{Plates} \\ \multicolumn{3}{c}{**Group IV—Special healthcare wastes**} & Contaminated packaging \\ \multicolumn{3}{c}{Electronic equipment} \\ \multicolumn{3}{c}{Batteries} \\ \multicolumn{3}{c}{Formaldehyde wastes} \\ \hline \hline \end{tabular}
\end{table}
Table 2: Details of the elements included in the different waste groups produced by the hospital in 2019.  
inventory. Midpoints are quantifiable and can be used to track the original emissions, but cannot entirely indicate the total damage to the chain. The damages are caused by impacts, which are endpoints of the chain. Endpoints represent the inevitable damages. Therefore, to obtain a global representation in this study of the inevitable damage caused by hospital activities, the endpoint ReCiPe method was selected, and included three endpoint impact categories: damages to human health, the ecosystem, and depletion of resources. For this first calculation, the data were summed up to a single total impact value.  
Secondly, by selecting the calculation methodology CML-IA baseline V3.05/EU25, environmental impacts were assessed, classified, and evaluated in 11 impact categories. The impact categories analysed were abiotic depletion (AD), fossil depletion (ADF), global warming potential for a 100-year time horizon (GWP), ozone layer depletion (ODP), human toxicity potential (HTP), fresh water aquatic ecotoxicity (FWAE), marine aquatic ecotoxicity (MAETP), terrestrial ecotoxicity (TE), photochemical oxidant creation potential (POCP), acidification potential (AP), and eutrophication potential (EP). The CML-IA IA baseline V3.05/EU25 methodology is one of the most widely used in the scientific literature on life cycle assessments. It also allows researchers to analyse the environmental impacts in the specific categories to be studied. On the other hand, the CML-IA methodology is a midpoint methodology that does not incorporate the grouping and weighting phases, and therefore avoids the incorporation of subjectivity in the results.