ENDOSCOPY
“Plastic waste is often considered to be ‘unavoidable’, but is it really? Waste can be easily segregated into different streams and the processing of these streams are charged differently,” he commented. “We need to consider whether we can recycle and even reuse our plastic waste. Face masks, aprons, visors and curtains can all be potentially recycled, and recent papers have outlined how gowns can be reused for theatres and endoscopy…This will help us to reduce our footprint,” Prof. Sebastian continued. At Hull University Teaching Hospitals, a circular economy has been created by collecting sterilisation tray wrap and drapes and placing them in a Sterimelt machine. Initially developed to recycle polypropylene surgical tray wraps and drapes in hospitals, TCG (the manufacturer of the machine) has since adapted the device to also recycle medical-grade surgical face masks and other types of PPE. The device works by heating polypropylene plastic up to 350°C in 20kg batches and then thermally compacting it into rectangular blocks that can then be converted into pellets to make new plastic products. “Most of the plastic waste generated by our endoscopy department can be recycled in this way,” he reported.
Hospitals can also make small changes such as implementing a ‘waste sorting grid’ to assist staff in sorting waste from endoscopic procedures into appropriate waste stream bins; identifying and eliminating unnecessary plastic components for storage of items, is another easy win. However, he asserted that we need to “think bigger”. “We have looked at mapping out the carbon footprint of an endoscopy unit and found two important areas, in terms of energy consumption, were in the reprocessing and washing of endoscopes,” he commented. The total energy consumption for an endoscopy unit, per day, was calculated to be 120.5kWh.6
for 24.67kWh of energy usage and scope reprocessors accounted for 27kWh, while lighting accounted for 47.88kWh, anaesthesia machines accounted for 12kWh and computers 8.96kWh. In terms of water usage, decontamination uses 70-100 litres per cycle. This includes 20-30 litres for the manual wash and 50-70 litres in AER. “Whether RO water is necessary for all of these processes is up for debate. But what really concerns me is the multiple plastic bottles of water that are used for flushing the colon during colonoscopy. Is this really needed?” he continued. Industry and the supply chain must also do their part, he argued, suggesting that procurement must be held to account. Packaging and delivery need to be scrutinised, while innovation and carbon reductions by manufacturers must also be considered.
Pentax Medical’s PlasmaTYPOON+ and PlasmaBAG system, for example, can replace up to four drying cabinets, reduce energy bills and carbon footprint by up to 4.25 tonnes per drying cabinet per year, while scopes are completely dry in just 1-3 minutes. The same process takes hours in a drying cabinet. This means it can be ready for immediate use, or stored for up to 31 days in the PlasmaBAG.3 “These energy savings will be further evaluated in a multi-centre UK study,” he revealed, adding that, for the next generation PlasmaBAG, there is also a commitment to make the solution almost completely recyclable. “This is the type of commitment we should be looking for from industry,” he asserted.
Washer machines accounted
He went on to discuss single-use endoscopes and the considerations from an environmental perspective: “I fully understand the concerns about the risk of infection, particularly in some high- risk procedures, using bronchoscopes, ureteroscopes and duodenoscopes. Industry has come up with a number of single-use devices, which I have concerns about in relation to the environment,” he commented. He went on to outline the material components of a disposable scope, pointing out that only 48% is recyclable. According to analysis by Namburar et al, if all endoscopic procedures were performed with single-use endoscopes and accounting for reprocessing, the net waste mass would increase by 40%. Excluding waste from ancillary supplies, net waste generated from reprocessing and endoscope disposal would quadruple with only using single-use endoscopes.7 “We need innovative solutions to create a balance between addressing the risk of infection and the risk to the environment. I’m sure there will be a happy medium, where we come together as academics, endoscopists and manufacturers, to tackle both these aspects,” he commented. “This is already happening,” he continued. He highlighted an alternative to single-use duodenoscopes from Pentax Medical, which features a disposable distal endcap and is aimed at significantly reducing the risk of infection. “Other manufacturers have also followed
suit…so, we do have solutions which help balance this risk,” he commented. Ultimately, he believes there is a need to offer the power of choice, providing the right solution for every patient. Single-use bronchoscopes should be available for some high-risk patients, but there should not be a “wholesale move to single-use”. “Endoscopy needs to reinvent itself for a sustainable future and fast. We need to be part of the solution, not the problem; industry needs to play its part; and we simply cannot go back to ‘business as usual’ – our planet needs us,” he concluded. CSJ
62 l
WWW.CLINICALSERVICESJOURNAL.COM
References 1. Ofstead CL, Quick MR, Wetzler HP, Eiland JE, Hey- mann OL, Sonetti DA, Ferguson JS. Effectiveness of Reprocessing for Flexible Bronchoscopes and Endobronchial Ultrasound Bronchoscopes. Chest. 2018 Nov;154(5):1024-1034. doi: 10.1016/j. chest.2018.04.045. Epub 2018 May 31. PMID: 29859183.
2. Ofstead CL, Heymann OL, Quick MR, Johnson EA, Eiland JE, Wetzler HP. The effectiveness of steriliza- tion for flexible ureteroscopes: A real-world study. Am J Infect Control. 2017 Aug 1;45(8):888-895. doi: 10.1016/j.ajic.2017.03.016. Epub 2017 Jun 15. PMID: 28625700.
3. Validated for up to 744 storage hours (31 days) according to NF EN 16442 norm. The maximum storage time may be subject to local regulations on endoscope storage.
4. Mouritsen JM, Ehlers L, Kovaleva J, Ahmad I, El-Boghdadly K. A systematic review and cost effec- tiveness analysis of reusable vs. single-use flexible bronchoscopes. Anaesthesia. 2020 Apr;75(4):529- 540. doi: 10.1111/anae.14891. Epub 2019 Nov 8. PMID: 31701521; PMCID: PMC7079200.
5. Maurice JB et al, Green Endoscopy: a call for sustainability in the midst of COVID-19, Lancet Gastroenterol Hepatol. 2020.
6. Gayam, S, Environmental impact of endoscopy: ‘scope’ of the problem, Am J Gastroenterol, 2020
7. Namburar S, von Renteln D, Damianos J, Bradish L, Barrett J, Aguilera-Fish A, Cushman-Roisin B, Pohl H. Estimating the environmental impact of dispos- able endoscopic equipment and endoscopes. Gut. 2021 Dec 1:gutjnl-2021-324729. doi: 10.1136/ gutjnl-2021-324729. Epub ahead of print. PMID: 34853058.
The event...
The online conference, Patient Safety, Hygiene and Sustainability: discussing solutions for today’s challenges in endoscopy, covered a number of key themes, including: l The power of choice in bronchoscopy. l The importance of endoscope drying to minimise the risk of infection.
l Sustainable endoscopy. l The necessity and value of training for endoscopy reprocessing staff. Other expert speakers included: l Dr. Lionel Pineau, scientific, technical and innovation director, Eurofins Biotech Germande.
l Meredith Smart, Owner and CEO, 20/30 Labs.
l Satsuki Amano, global product manager single-use endoscopes, Pentax Medical EMEA.
l Michael Unger, general manager marketing, product and business development EMEA, Pentax Medical.
l Mihaela Cirisan, engineer product specialist, PlasmaBiotics.
JUNE 2022
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
