Sustainable healthcare
Green endoscopy: a call to action
At the Central Sterilising Club (CSC) Autumn study day, on the 10th October 2022, in Manchester, sustainability was high on the agenda. The event included some thought- provoking discussions on how the environmental impact of decontamination and endoscopy departments could be minimised. Louise Frampton reports.
Speaking at the CSC Autumn study day, Professor Bu’Hussain Hayee, professor of gastroenterology at King’s College London (KCL), gave a call to action to join the ‘movement for sustainable practice’. He explained that endoscopy is the third highest generator of waste in healthcare.1,2
There are a number of
reasons for this: endoscopy involves a high throughput of cases; it has multiple non- renewable waste streams; it requires resource- heavy decontamination processes; and it involves numerous hospital visits for patients and relatives. Each endoscopy generates 2.1kg of disposable waste (46L volume)2
and most of this waste
goes to landfill (64%). Biohazardous waste accounts for around 28%, while only 9% of waste is recycled. There is significant room for improvement, therefore. The WHO is calling for action and states that the majority of healthcare waste should be recycled. But to support this, more data is required.
“There are huge efforts in the fields of
gastroenterology and endoscopy in the past few years, so data will support our practice in the future,” Prof. Hayee commented. These efforts are being undertaken against
a backdrop of the NHS Net Zero targets. The NHS aims to be ‘Net Zero’, for the emissions it controls directly, by 2040 (an 80% reduction from the 1990 baseline by 2028-32), while the Net Zero Carbon Footprint Plus target, for emissions that the NHS can influence, must be achieved by 2045 (an 80% reduction by 2036-39). Prof. Hayee explained that the ‘Net Zero Carbon Footprint Plus’ looks at the contribution of the wider NHS supply chain.
He said that the NHS Net Zero target is “ambitious but realistic” and pointed out that there have been significant steps forward already. From 2010 to 2017, NHS water consumption was reduced by 21% – the equivalent to around 243,000 Olympic swimming pools. This was achieved even before the Net
Zero targets were put in place, but – as Prof. Hayee points out – there is still a long way to go. Prof. Hayee revealed that the NHS has a carbon footprint of over 6 MtCO2e and, for carbon footprint plus, the figure is nearly 25 MtCO2e – this is the equivalent of the emissions profile for Croatia. NHS England’s breakdown of the NHS carbon footprint shows that the majority of NHS emissions are generated from “medicines, equipment and other supply chain”. He went on to present figures for the
current carbon footprint of endoscopy, which suggest that one endoscopy generates around 2kgCO2e – the equivalent of driving five miles. This is based on the energy consumption alone, however, and does not include consumables or equipment.
“When you consider how many procedures we perform, in the UK, that is a lot of ‘miles driven’,” he commented. “We saw how the world mobilised during the pandemic – but climate change poses a significant and existential threat, far greater than COVID-19. So, let’s make the effort to address this aspect of our practice too,” he asserted. “The climate crisis has not gone away. The
COVID-19 pandemic has given us pause to change how we practice. But the 5.5% reduction in emissions globally is not enough. Global temperatures have risen 1.1 degree C above pre- industrial levels.” He pointed out that it is not just carbon emissions that we need to address – in 2017, the UN warned of a ‘planetary crisis’ being caused by ocean plastic. By 2019, ocean plastic was reported to be “visible from space”. Prof. Hayee gave a thought-provoking
reminder of why climate change and the impact of healthcare on the environment is a threat that must be taken seriously, by showing a map of land in the UK projected to be below the annual flood level in 2030. “If you focus in on King’s College in London,
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