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.

GI endoscopy is highly resource-intensive with a significant contribution to greenhouse gas (GHG) emissions and waste generation. Sustainable endoscopy in the context of climate change is now the focus of mainstream discussions between endoscopy providers, units and professional societies. In addition to broader global challenges, there are some specific measures relevant to endoscopy units and their practices, which could significantly reduce environmental impact. Awareness of these issues and guidance on practical interventions to mitigate the carbon footprint of GI endoscopy are lacking. In this consensus, we discuss practical measures to reduce the impact of endoscopy on the environment applicable to endoscopy units and practitioners. Adoption of these measures will facilitate and promote new practices and the evolution of a more sustainable specialty.

Reducing the carbon footprint for a 30-bed haemodialysis unit by changing the delivery of acid concentrate supplied by individual 5 L containers to a central delivery system.

BACKGROUND: Haemodialysis treatments generate greenhouse gas (GHG) emissions mainly as a result of the equipment, consumables and pharmaceuticals required. An internal audit demonstrated a 33% wastage of acid concentrate when using individual 5.0 L containers at a 1:44 dilution ratio. We therefore investigated whether changing the delivery system for acid concentrate would reduce wastage and any associated greenhouse gas emissions. METHODS: We calculated the difference for a 30-bed dialysis unit between receiving acid concentrate in single-use 5.0 L plastic containers versus bulk delivery for a central acid delivery system connected to the dialysis machines. Estimates of carbon dioxide equivalent (CO2e) emissions were made using the United Kingdom government database and other sources. RESULTS: A 30-station dialysis unit functioning at maximum capacity (3 shifts and 6 days/week), switching to bulk delivery and central acid delivery could realise an approximate total reduction of 33,841 kgCO2e/year; in reduced product wastage, saving 6192 kgCO2e, 5205 kgCO2e from fewer deliveries, and 22,444 kgCO2e saving from a reduction in packaging and waste generated, which equates approximately to a one tonne reduction in CO2e emissions per dialysis station/year. CONCLUSIONS: Switching from delivering acid concentrate in individual 5.0 L containers to a central acid delivery system can result in substantial reductions in CO2e emissions within a dialysis clinic. The emission savings from reducing the single-use plastic packaging greatly outweigh any gains from eliminating wastage of acid concentrate. Dialysis companies and clinicians should consider reviewing the design of current and future dialysis facilities and policies to determine whether reductions in CO2e emissions can be made.

The carbon footprint of Bubble-PAPR™: A novel item of personal protective equipment.

Background: Personal protective equipment has important environmental impacts, assessing these impacts is therefore an important element of personal protective equipment design. We applied carbon footprinting methodology to Bubble-PAPR™, a novel, part-reusable and part-recyclable powered air-purifying respirator, designed at our institution. Current guidance states that disposable respirator masks can be worn for 1-h in the United Kingdom, whilst the Bubble-PAPR™ allows prolonged use. Methods: Following a detailed use-case analysis, the carbon footprint of each component was estimated using a bottom-up (attributional) cradle-to-grave process-based analysis. Modelling considered the use of virgin or closed loop recycled polyvinyl chloride for the disposable hood element, and disposal via infectious or recycling waste streams to estimate a per-use carbon footprint. Results: The per-use carbon footprint with manufacture from virgin polyvinyl chloride and disposal via incineration is 0.805 kgCO2e. With nine cycles of closed loop recycling and manufacture of the polyvinyl chloride hood (10 uses), the carbon footprint falls to an average of 0.570 kgCO2e per use. Conclusion: Carbon footprinting may contribute to the value proposition of this novel technology. We estimate that a single Bubble-PAPR™ use has a higher carbon footprint than disposable respirator mask-based PPE. However, this is mitigated in circumstances when multiple disposable mask changes are required (e.g. prolonged use) and use may be justifiable when user comfort, visualisation and communication with patients and colleagues are essential.