Targeted intervention to achieve waste reduction in gastrointestinal endoscopy

Abstract

ObjectiveEndoscopy is healthcare’s third largest generator of medical waste in hospitals. This prospective study aimed to measure a single unit’s waste carbon footprint and perform a pioneer intervention towards a more sustainable endoscopy practice. The relation of regulated medical waste (RMW; material fully contaminated with blood or body fluids or containing infectious agents) versus landfill waste (non-recyclable material not fully contaminated) may play a critical role.DesignIn a four-stage prospective study, following a 4-week observational audit with daily weighing of both waste types (stage 1), stage 2 consisted of a 1-week intervention with team education of waste handling. Recycling bins were placed in endoscopy rooms, landfill and RMW bins were relocated. During stages 3 (1 month after intervention) and 4 (4 months after intervention), daily endoscopic waste was weighed. Equivalence of 1 kg of landfill waste to 1 kg carbon dioxide equivalent (CO2e) and 1 kg of RMW to 3kgCO2e was assumed. Paired samples t-tests for comparisons.ResultsFrom stage 1 to stage 3, mean total waste and RMW were reduced by 12.9% (p=0.155) and 41.4% (p=0.010), respectively, whereas landfill (p=0.059) and recycling waste increased (paper: p=0.001; plastic: p=0.007). While mean endoscopy load was similar (46.2 vs 44.5, p=0.275), a total decrease of CO2e by 31.6% (138.8kgCO2e) was found (mean kgCO2e109.7 vs 74.9, p=0.018). The annual reduction was calculated at 1665.6kgCO2e. All these effects were sustained 4 months after the intervention (stage 4) without objections by responsible endoscopy personnel.ConclusionIn this interventional study, applying sustainability measures to a real-world scenario, RMW reduction and daily recycling were achieved and sustained over time, without compromising endoscopy productivity.

Life cycle assessment of routinely used endoscopic instruments and simple intervention to reduce our environmental impact

“…In the surgical field, laparoscopic hysterectomy, cataract surgery, neurosurgery and skin cancer surgery produce 12.0, 3.0, 8.9 and 2.6 kg of waste, respectively 12 16–18. In GI endoscopy, several publications have estimated the total waste of a single endoscopy procedure (0.5–2.1 kg) 7 8 19. In our study, only taking into account biopsy forceps, polypectomy snares and haemostatic clips, total BMW per procedure was approximately 0.05 kg.…”

“…In our study, only taking into account biopsy forceps, polypectomy snares and haemostatic clips, total BMW per procedure was approximately 0.05 kg. Cunha Neves et al demonstrated that after an educational staff intervention, it was possible to reduce general landfill waste and BMW, and thus minimise waste carbon footprint 8. They achieved a reduction of total waste and BMW by 12.9% and 41.4%, respectively, and a total decrease of carbon footprint by 31.6% 8.…”

“…Cunha Neves et al demonstrated that after an educational staff intervention, it was possible to reduce general landfill waste and BMW, and thus minimise waste carbon footprint 8. They achieved a reduction of total waste and BMW by 12.9% and 41.4%, respectively, and a total decrease of carbon footprint by 31.6% 8. However, both waste and different material components were characterise and provided data about full LCA (production, transportation and disposal) of single-use instruments, and then determined total carbon footprint.…”

“…Each single endoscopy procedure generates on average up to 2.1 kg of general waste, being regular waste (63%), BMW (28%) and recyclable (9%) waste 7. Simple sustainability interventions such as team education in terms of waste handling, segregation and disposal may result in a total decrease of carbon emissions by 31.6% 8. The European Society of Gastrointestinal Endoscopy has recently released a statement addressing several proposals to reduce our environmental footprint (EF) to avoid unnecessary procedures, favouring less invasive diagnostic tests creating recycling strategies 9…”

Estimating the environmental impact of endoscopic activity at a tertiary center: a pilot study

“…Indeed, poor medical waste management has harmful economic and ecological impacts. Educational measures regarding recycling and appropriate waste management have been demonstrated to be efficient and do not compromise productivity [17]. Also, increasing the proportion of effectively recycled waste will decrease the carbon footprint of endoscopic units and the costs associated with waste management as recycled items can receive economic valorization.…”