A Quality Improvement Study to Investigate and Reduce the Overall Environmental Impact of Procedures on Our Overall Healthcare Carbon Footprint

Introduction: US healthcare related industries are estimated to account for 8-10% of the nation's total greenhouse gas emissions (GHG), and appear to be increasing. Procedure based specialties such as endoscopy are one of the major contributors to GHG production. Methods: A 5 day audit of all endoscopies performed by a single provider over a span of 4 weeks in one endoscopy unit at a community-based hospital that does not recycle materials was performed. A quantitative assessment was performed measuring recyclable items using an inventory of items used during endoscopy, and determination of recyclable items (ex: 60 cc syringes, distilled water bottles). We also created a list of recyclable material from equipment packaging including boxes, cartons, mounting cards, literature and hoops. During the endoscopy, we separated all recyclable materials and placed them in the newly added recycling bin. At the end of each day, we weighed the recyclable materials using a Scale-Tronix ST engineer-calibrated scale. We then calculated the average daily recyclable waste generated during each endoscopy and the total recyclable waste generated per year. Results: Each box of recyclable equipment contained 40 forceps, 40 slip tips, 50 mL syringes and 20 captivator cold snare per box respectively. Our first 5 days of weighing recyclables we measured 5.0 kg, 1.7 kg, 2.8 kg, 2.4 kg and 2.1 kg (2.1-5.0 kg) of waste respectively as shown in Table 1. The first day with 5.0 kg includes the packaging the equipment came in that day. The average amount of recyclable waste was 2.8 kg. Total recyclable waste for the 5 day period was 14 kg. The average amount of recyclable waste generated per endoscopy was 14 kg of recyclable waste/49 scopes = .285 kg (.21-.5 kg). The amount of endoscopies varied with a range of 8-12 procedures each day with varying numbers of upper and lower endoscopies. An estimate of annual recyclable waste for this endoscopist is 296.4 kg per year based on having two endoscopy days per week. We calculated the total recycable waste our endoscopy unit creates in a year by 2.8 kg per suite x 7 endoscopy suites= 19.6 kg per day x 5 days= 98 kg per week x 52 weeks in a year = about 5,096 kg of recyclable waste generated annually. Conclusion: Our study documents waste production and recyclable material generated by a single endoscopist in a community-based hospital system. Recycling of endoscopy materials represents an easily achievable method to reduce an estimated 5,096 kg of annual waste in our endoscopy unit. Table 1. - Demonstrates the Amount of Endoscopies Performed Per Day and the Measured Recyclable Waste Generated Date of Service Scope Count Upper (EGD) Lower (Colon) Weight (kg) Average Waste Per Scope (kg) 4/24/23 10 2 8 5.0 .5 5/3/23 8 3 5 1.7 .21 5/10/23 12 6 6 2.8 .23 5/22/23 9 3 6 2.4 .26 5/24/23 10 3 7 2.1 .21