Sustainable healthcare
the flood margins come right up to our front door; this is extremely sobering. It is a stretch between what we are doing on a day-to-day basis and flood risk, but it brings the issue close to home. It is not just ‘someone else’s problem’.” Before the pandemic, a group called ‘Green
Endoscopy’ was established. The group of interested individuals has steadily grown and there have been some significant successes. A number of research papers have now been published and the Green Endoscopy group has worked closely with – and enthused – organisations such as: the Centre for Sustainable Healthcare, BSG, JAG and ESGE.3 Together, they have developed consensus
statements and produced guidance on how endoscopy can be practised in a more sustainable way. This included an update to JAG’s global rating scale (GRS) in 2021, which highlighted the need for the service to have a green endoscopy working group. It also highlighted the need to reduce waste in endoscopy and for the service to “reflect hospital objectives to improve environmental impacts”. The latest BSG guidelines3
also include
a number of statements regarding green endoscopy: l The design of new decontamination units must include sustainability as an explicit criterion for procurement of hardware and consumables.
l Water is used in endoscope decontamination, peri-procedural flushes and for immersion colonoscopy. An agreed standard operating procedure should exist to ensure rationalisation and minimisation of water use.
l There should be further research into sustainable alternatives to mitigate the environmental impact of sterile water use in the endoscopy unit, while meeting infection control standards.
Prof. Hayee pointed out that, of the total amount of waste generated by healthcare activities, around 85% is general, non-hazardous waste
(source: WHO), which means there is significant scope for recycling. “As a specialty, we have done a great deal
to establish who should have an endoscopy and who should not – the greatest waste is a procedure that did not need to be performed in the first place. But our push to be more sustainable absolutely cannot end with this basic function. “We can become more sustainable
throughout the whole pathway. When we look at the patient pathway, it is obvious that we can choose more sustainable alternatives,” said Prof. Hayee. The mantra “reduce, reuse and recycle” should be applied across the pathway and Gayam et al suggest that services can apply reductions in the following areas4
:
l Curb unnecessary procedures. l Move to paperless reports/electronic documentation.
l Favour cold snare polypectomy over diathermy.
l Reduce single use consumables. l Reduce nitrous oxide/general anaesthesia
As a specialty, we have done a great deal to establish who should have an endoscopy and who should not – the greatest waste is a procedure that did not need to be performed in the first place. But our push to be more sustainable absolutely cannot end with this basic function. Professor Bu’Hussain Hayee, King’s College London.
48
www.clinicalservicesjournal.com I April 2023
where possible.
l Use LED lights. l Procurement: move to bulk purchasing, low carbon alternatives, and alternatives to single use.
l Fill sharps bins full before disposal. l Avoid plastic bags/plastic cups. l Switch off unused lights/equipment. l Avoid overheating. l Cohort COVID+ patients to minimise cleaning/ PPE.
Reuse also has a contribution to make in the following areas: l Reuse the endoscope if not used for later procedure.
l Gastroscope for flexible sigmoidoscopy procedures for the same patient.
l Reuse cups/trays/endoscopes. l Us rechargeable batteries. l Distribute endoscopy solutions (e.g. lifting solutions/dye spray/acetic acid) between rooms.
l Washable sharps bin emptied into a central disposable collection point.
In terms of recycling, providers can: l Segregate waste disposal to individual recyclable components: l plastic, paper l cardboard l glass l metals.
l Increase availability of recycling bins. l Provide staff training on waste management. l Review waste recycling streams. l Use novel plastic recycling strategies, e.g. Sterimelt.
l Employ water reprocessing.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68
