Introduction
While GI endoscopy units serve an integral role in screening and diagnosis of a plethora of clinical conditions but could also be a source of environmental waste generation and energy consumption in form of plastic, sharps, personal protective equipment (PPE), cleaning supplies and energy. Evaluation of large data from one endoscopy center could serve as an actionable model for other centers in the health-system for environmentally sustainable endoscopy units.
Aims & Methods
We prospectively collected data on total waste generation of a single large academic VA based endoscopy unit (average 3500 procedures per year) over May-June 2022. We stratified the waste generated from esophagogastro-duodenoscopy and colonoscopy into biohazardous, non-biohazardous, or recyclable items to determine opportunities to improve/maximize the recycling of waste. Data on each item used for each patient since entry to the endoscopy unit and discharge including the endoscopy procedure, amount of waste generation per day for the entire unit, type of waste, energy utilization for each day, and reprocessing related waste generation for each procedure were analyzed. We also performed a review of endoscopy inventory utilized and audit of items utilized in each procedure. No patient information was collected, and study was approved by the local institutional review board.
Results
Data of 400 procedures collected over the study period was analyzed providing total waste generation of 1010.65 kg which include sharps (51.57 kg) and biohazard waste (336.34 kg). Average per day land-fill waste generation was 30.63 kg which approximates to 9,189 kg for an entire year. Despite 44% of items taken out from the inventory being recyclable, only 28% of them were used in the procedure per audit adding to the 8.6 kg. waste per day. Thus, intra-procedure inventory audit could reduce landfill waste by 20% per day (Figure 1). By scope cleaning and reprocessing, additional 194 gallon of liquids waste (=735.26 kg.) per day was generated. Two football field sized landfill waste is generated this way when total annual waste generation is considered. On average 277.1 kW hour energy was utilized for endoscopy unit alone per day which equals to 8.2 gallons of gasoline use per day.
Conclusion
Measures to reduce waste generation in form of reducing landfill and water waste are needed. Auditing and only using the inventory absolutely needed in a case could reduce the landfill waste by 20%. Improvement in methods aimed at environmentally effective scope reprocessing measures are immediately needed since this contributes to a significant source of total waste generation from the GI endoscopy as well.