Sustainable healthcare
Prof. Hayee commented that endoscopy services should also partner with industry; suppliers should be held to account: “Our procurement teams are becoming more and more empowered to ask questions around the sustainability credentials of suppliers. If they can’t help us meet our Net Zero target, we simply won’t be doing business with them. “We can apply pressure to suppliers by asking:
why are they supplying an item in a box that is big enough for five items? Why are they using plastic when they could be using cardboard? Why aren’t they using electric fleets? Why aren’t they consolidating deliveries of consignments to us? We need to put pressure on industry to change.” The message is starting to get through, he asserted, but there needs to be a proper (evidence-based) discussion around single use equipment. “We have mostly regarded plastic waste as
‘unavoidable’, but much of it is recyclable – it about having the right bins in your department,” he commented. The funding is already available, and it is an easy win. But it is important to record the outcomes and publicise this too,” he added. He pointed out that it is possible to recycle
one’s own plastic waste such as gloves, aprons, visors and curtains using a Sterimelt machine, which creates a block of sterilised plastic that can be sold on to plastics manufacturers, to create a circular economy. Tackling water usage is also key. It has previously been calculated that decontamination uses 90-100 litres of water per cycle (20-30 litres for the manual wash and 60-70 litres in the AER). Most modern AERs have reduced their water usage, however, and now use
around 24 litres per cycle. “This is still a significant amount of water usage, and most units use RO. It is convenient and high volume, but it is energy intensive. Could this be done differently? I don’t have the answers, but we use a great deal of effort, cost, and carbon, to ensure and assure our water quality in our endoscopy units,” commented Prof. Hayee. He posed the question: could ultrafiltration units be used, instead of RO? “Ultrafiltration produces pure water at
lower volumes, but could it be used in smaller units or for the community diagnostic hubs that are being set up around the country?” he pondered. In addition, he pointed that we are “putting sterile water into parts of the body where it seems unnecessary”. There needs to be discussion on how we can address the requirements of endoscope manufacturers, infection control, vs sustainability, he asserted. He urged delegates to educate themselves on sustainability and directed them to some of the resources available – including the Centre for Sustainable Healthcare, the Carbon Trust, the Sustainable Healthcare Coalition, and e-Learning for Healthcare, to name just a few.
Single use vs reusable Josh Blake, the endoscopy processing unit manager at Salford Royal Hospital, continued the theme of sustainability in endoscopy with a presentation on ‘the sustainability and cost of single use vs reusable endoscopy accessories.’ In his opening discussion, he looked at the benefits of reusable – there is no waste with reusable accessories (usually just the
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packaging material for transportation). When the endoscope accessories are reprocessed, they are reprocessed with the endoscope, which means no additional water or chemicals are used, although there may be an additional brush that is used. In terms of cost, a full set of reusable accessories can be up to 10-20 times the cost of one single use set. However, this cost is offset; for example, some specific models of endoscope suggest 300 reprocesses before discarding the accessories. He added that this makes a big difference in terms of cost, when you compare this with around £9 per patient when moving over to single use. In terms of performance, he commented
that reusable endoscope accessories are often the preferred choice of consultants – reusable endoscope accessories are generally perceived to be manufactured with higher quality materials. Some consultants may have been put off by past experiences, but single use accessories are now much higher quality today. He went on to consider the negatives of
reusable. Use of reusable accessories require additional steps/risk assessments to ensure proper traceability of the accessories. This may mean the use of disposable valve carriers is required, negating the waste saved. He concluded that in terms of sustainability, the difference is “negligible” between reusable and single use endoscope accessories. He added that the tracing of reusable accessories can prove almost impossible, however. For example, once the accessory has left the department, it can easily be transferred between endoscopies – valves and buttons
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