Commercial composting in the Green Endoscopy Unit- the next goal for waste reduction?

Multiple frameworks are available for reducing the carbon footprint in endoscopy units, including simple solutions such as powering down when not in use and double-sided printing (Sebastian et al., 2023). However, one major environmental impact is the large volume of waste generated, and in the last decade there has been greater awareness of the environmental impacts caused by single use items (Agrawal et al., 2017; Desai et al., 2023). Recycling seems a logical first step for units to start their green journey, however a low proportion of waste in endoscopy units is recyclable- as little as 0.3% in one study! (Azouz et al., 2019; Namburar et al., 2022; Petre et al., 2019; Gayam 2020).

The move away from single use consumables such as plastic bowls, pottles and gowns, and replacing these with compostable alternatives is a relatively simple thing to implement with numerous compostable and biodegradable products now available. On its own this is not going to have the desired effect of decreasing landfill and greenhouse gas (GHG) emissions as biodegradable products will break down eventually in landfill, but it will still take a long time due to it being an anaerobic environment with no dirt, microbes, fungi or bacteria (Earth Talk, 2023).

This is where commercial composting comes into play with most major centres now having collections and commercial composting facilities available. Biodegradable waste breaks down within weeks and ends up as a fine futile soil rather than filling landfills. The process is cleaner, faster, produces less GHG emissions than landfills and never fills up. It involves high temperatures to kill pathogens and bacteria but also provides an aerobic environment with organic matter and microbes which breaks down waste at high speeds. Implementing this can be more challenging than adding a recycling bin to a room however in the long run is much more beneficial. It means a change in the way waste management on the hospital site is conducted with different bins next to landfill and recycling bins, however this doesn’t mean needing more space due to the significant decrease in landfill waste that will occur. It means more than just the biodegradable pots and gowns but all food waste and paper towels which take up a lot of area in landfill bins. The most important factor is education, education, education for staff to ensure correct items are directed to the right bins. However once implemented and effectively managed it could quickly lead to a reduction in endoscopy waste going to landfill.

These are aspirational ideas to aim for but tomorrow what can you do in your endoscopy unit? A good way to start the introduction of ‘green endoscopy’ to your unit is the creation of a ‘green team’, a key theme in the literature (Azouz et al., 2019; Petre et al., 2019; Pohl, 2023; Sebatian et al., 2023), and the first step towards staff buy-in. The green team is created with like-minded individuals, who can assess the attitudes of other staff, create a shared understanding of the meaning green, and provide information about waste segregation and sustainable principles (Azouz et al., 2019; Donnelly, 2022; Petre et al., 2019; Pohl, 2023; Sebatian et al., 2023).

References:

Agrawal, D., Shoup, V., Montgomery, A., Wosik, J., & Rockey, D. C. (2017). Disposal of endoscopic accessories after use: Do we know and do we care? Gastroenterology Nursing, 40(1), 13–18. https://doi.org/10.1097/SGA.0000000000000280

Azouz, S., Boyll, P., Swanson, M., Castel, N., Maffi, T., & Rebecca, A. M. (2019). Managing barriers to recycling in the operating room. The American Journal of Surgery, 217(4), 634–638. https://doi.org/10.1016/j.amjsurg.2018.06.020

Desai, M., Campbell, C., Srinivasan, S., Higbee, A., Patel, H., Radadiya, D., & Sharma, P. (2023). A detailed and prospective analysis of the environmental impact of waste generation and energy consumption from GI procedures. Gastrointestinal Endoscopy, 97(6), AB848. https://doi.org/10.1016/j.gie.2023.04.1374

Donnelly, L. (2022). Green endoscopy: Practical implementation. Frontline Gastroenterology, 13(e1), e7–e12. https://doi.org/10.1136/flgastro-2022-102116

Earth Talk. (2023). Do Biodegradable Items Degrade in Landfills? Retrieved from: thoughtco.com/do-biodegradable-items-really-break-down-1204144

Gayam, S. (2020). Environmental impact of endoscopy: “scope” of the problem. American

Journal Gastroenterology, 115: 1931–1932

Namburar, S., Von Renteln, D., Damianos, J., Bradish, L., Barrett, J., Aguilera-Fish, A., Cushman-Roisin, B., & Pohl, H. (2022). Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut, 71(7), 1326–1331. https://doi.org/10.1136/gutjnl-2021-324729

Petre, M.-A., Bahrey, L., Levine, M., Van Rensburg, A., Crawford, M., & Matava, C. (2019). A national survey on attitudes and barriers on recycling and environmental sustainability efforts among Canadian anesthesiologists: An opportunity for knowledge translation. Canadian Journal of Anesthesia/Journal Canadien d’anesthésie, 66(3), 272–286. https://doi.org/10.1007/s12630-018-01273-9

Pohl, H. (2023). Transitioning to sustainable care and green endoscopy. Gastroenterology and Hepatology, 19(4), 233–236.

Sebastian, S., Dhar, A., Baddeley, R., Donnelly, L., Haddock, R., Arasaradnam, R., Coulter, A., Disney, B., Griffiths, H., Healey, C., Hillson, R., Steinbach, I., Marshall, S., Rajendran, A., Rochford, A., Thomas-Gibson, S., Siddhi, S., Stableforth, W., Wesley, E., … Hayee, B. (2023). 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, 72, 12–26.