Sustainable healthcare
are particularly problematic, he pointed out. This can be for a number of reasons – if one of the buttons is dropped during a procedure, a staff member may swap the button from another clean endoscope to ensure that the procedure goes ahead. A small action like this can compromise traceability. There is a need to educate theatre staff on this, but a small amount of single use items for just this type of occurrence may also provide the solution. With regards to infection control, there are
other negatives associated with reusable, he asserted. Due to the construction of endoscope buttons, endoscope washers are unable to effectively clean the accessories, leaving behind chemical residue and other bacteria. An independent case study was carried out in September 2011.
An independent laboratory performed testing on 64 endoscope buttons across 20 different sites. The endoscope buttons were a mixture of air/water and suction valves from a variety of manufacturers. The independent laboratory requested that that they were only sent used, but reprocessed patient-ready endoscope buttons. The results showed that: l 56% detected bacteria, moulds, yeasts and/or bacteria spores (1 out of 2 valves tested).
l 20% detected endotoxin/pyrogen (1 out of 5 valves tested)
l 71% detected reprocessing chemical residue (3 out of 4 valves tested).
He went onto illustrate in more detail the challenges around reprocessing due to the complexity of the construction of buttons. Manufacturers have been taking steps to address some of these design issues, but there is a need for further work in this area. The benefit for single use is the fact that the item is sterile for every patient, eliminating the concern of cross contamination. If any endoscope buttons are dropped/damaged during a procedure, another pack can be opened. In terms of traceability, each sterile set of buttons received will contain a unique tracking number which can be traced back to the manufacturer. Any issues with specific endoscopes/patients (such as CJD) can be localised. He added that manufacturers, in recent years,
have been working on solutions to the concerns raised by the consultants – quality has been the focus, in the past few years, to ensure ease of use and as much ‘like-for-like’ use as possible, compared with reusable accessories. However, this comes at an elevated price – usually £6-£10 per patient. Cost is usually site specific, depending on requirements. Sustainability is another consideration – the use of single use products has a “huge toll on sustainability”, he pointed out. “There is usually a large amount of waste
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which comes into play when it comes to any products that are single use, but you need to get across to users that the packaging is usually recyclable, depending on the manufacturer. So, you can recycle parts of this,” he continued.
What else can be done? Ultimately, to move the sustainability agenda forward, he believes the key is to work with manufacturers. He concluded that single use is the way forward to protect against potential cross contamination. However, to overcome barriers around cost, there is an opportunity to work with manufacturers to look at pricing. This could mean grouping sites together to look at discounts due to higher numbers ordered. To address challenges around consultant
preference and hesitancy, it is important to discuss with the team of consultants the possibility of conducting trials. It may have been a long time since the consultants have trialled single use buttons. He also suggested looking at split packs – perhaps a full set of accessories is not required (i.e. you may need buttons but there is no need for a biopsy valve or cleaning adaptor), reducing cost and waste. “In terms of sustainability, considering that
valve carriers are used at a lot of sites to aid with traceability, there very little difference in waste between reusable and single use,” he commented. He added that there are opportunities to recycle that need to be explored, however. It will be up to the manager of each site to decide what is best for their unit. Smaller sites may find a change to single
use much easier, and the knock-on effect of the cost/waste will be minimal. Larger sites could perhaps look at a hybrid system – single
use for loan endoscopes, for which we do not have sufficient traceability, and reusable for their inhouse endoscopes. He concluded that if a manufacturer could provide a device that cleans reusable effectively, that would eliminate a large negative to reusable.
References 1. Vaccari M, Tudor T, Perteghella A. Costs associated with the management of waste from healthcare facilities: An analysis at national and site level. Waste Manag Res. 2018 Jan;36(1):39-47. doi: 10.1177/0734242X17739968. Epub 2017 Nov 14. PMID: 29132259.
2. Siau K, Hayee B, Gayam S. Endoscopy’s current carbon footprint. Tech Innov Gastrointest Endosc 2021;23:344–352.
3. Sebastian S, Dhar A, Baddeley R, Donnelly L, Haddock R, Arasaradnam R, et al. Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy. Gut 2023;72:12–26.
https://doi.org/10.1136/ gutjnl-2022-328460.
4. Gayam S. Environmental Impact of Endoscopy: “Scope” of the Problem. Office J Americ Coll Gastro 2020;115:1931.
https://doi.org/10.14309/ ajg.0000000000001005.
Additional resources
https://www.bsg.org.uk/clinical-resource/ green-endoscopy-bsg-jag-csh-joint-consensus- on-practical-measures-for-environmental- sustainability-in-endoscopy/
https://www.england.nhs.uk/greenernhs/a-net- zero-nhs/
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