Successful applicants to the ASGE Endoscopy Unit Recognition Program submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The quality assurance and performance improvement (QAPI) project in the spotlight this month looked at decreasing the amount of waste placed in biohazardous bins as a way to reduce the endoscopy unit’s carbon footprint.

Define

The relationship between medicine and climate change has been increasingly recognized by international medical societies. A 2022 initiative co-sponsored by the American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and ASGE codifies the urgent need for gastroenterologists to recognize that action is needed within our field to mitigate the effects of climate change.¹ One avenue of improvement outlined in this GI multi-society guideline is to minimize the carbon footprint and generation of waste within our clinical practice. Gastrointestinal endoscopy units are known to be major waste-producing areas in a hospital. One tertiary-care academic endoscopy unit generated 303 kg of solid waste and 1385 gallons of liquid waste for every 100 procedures.² Such waste often requires off-site reprocessing and incineration, which generates further greenhouse gases.

In our endoscopy unit, both solid and liquid waste are often disposed of in marked biohazardous bins transported off-site by a third-party vendor to be incinerated. We have observed that much of the waste generated during a procedure is not biohazardous and can be disposed of in regular waste bins typically sent to a landfill. Such waste includes packaging and gowns that are not heavily soiled. Our ambulatory surgical center currently does not support recycling.

The goal of our quality improvement project is to reduce the amount of waste placed in biohazardous bins, which carries a much higher carbon footprint than regular waste. We planned to directly train all endoscopy staff and place visual reminders throughout the endoscopy unit regarding which items meet the criteria for biohazardous waste.

Measure/Improve

We first measured the weight of biohazardous waste generated daily in our endoscopy unit over a week. We then held a meeting with endoscopy staff to discuss which common waste items can be disposed of in biohazardous waste bins versus regular waste bins. We reinforced this teaching by placing placards throughout the endoscopy unit listing items acceptable for biohazardous waste bins. After this intervention, we waited a month to allow staff to habitually change their waste disposal practices and again measured the weight of biohazardous waste generated daily over a week. The number of procedures performed during the pre- and post-intervention weeks were identical.

Analyze

The average pre-intervention weight of biohazardous waste generated daily was 476.0 kg. The average post-intervention weight of biohazardous waste generated daily was 95.2 kg, which is an 80% reduction.

Control

Given the significant reduction in waste requiring incineration, a number of biohazardous waste bins were able to be exchanged for regular waste bins in the endoscopy unit. We chose to keep placards throughout the unit, reminding staff of what waste goes in which bin. Future efforts to create a more environmentally friendly endoscopy unit will focus on reducing the use of single-use plastics and introducing a recycling program throughout the ambulatory surgical center.

References

1. Pohl H, de Latour R, Reuben A, et al. GI multisociety strategic plan on environmental sustainability. Gastroenterology. 2022;163:1695-1701.e2.
   
2. Desai M, Campbell C, Perisetti A, et al. The environmental impact of gastrointestinal procedures: a prospective study of waste generation, energy consumption, and auditing in an endoscopy unit. Gastroenterology. 2024;166:496-502.e3.
   

We hope sharing this project summary will be useful to you and your practice. Learn more about gaining honoree status in the ASGE Endoscopy Unit Recognition Program. EURP honoree units may use the ASGE Quality Star logo in promotion of their units, receive premium educational content bimonthly via an exclusive e-newsletter The Huddle, and enjoy a range of additional benefits. Questions should be directed to eurp@asge.org.