“The truth is: the natural world is changing. And we are totally dependent on that world. It provides our food, water, and air. It is the most precious thing we have and we need to defend it.”
Sir David Attenborough
Leigh Donnelly RGN, BSc (Hons), MA, PGDip(Ed)
Northumbria Healthcare Foundation
Editorial Board GIN
- Work with Teams and Management to achieve buy-in to departmental changes
- Think outside the box and explore new opportunities and services that can enhance recycling
- Develop a strong recycling ethos within and across teams
- Foster motivation and enthusiasm
Given the size and reach of the NHS, it is unsurprising that its activities are responsible for 6.3% of the UK’s total carbon emissions and 5% of the country’s total air pollution.1 These yields have direct consequences for health and spending. Rising temperatures due to global warming will lead to increasing levels of disease, an extra burden for which we are unprepared. The air pollution from particulate matter and nitrogen dioxide, both of which are products of combustion and fuel burning, is a proven risk factor for a long and expanding list of diseases.1
At current levels, the cumulative cost to the NHS of emissions over the next 16 years will be £9.4 billion for particulate matter, and £9.2 billion for nitrogen dioxide. The NHS cannot be an environment which contributes to the ill health of the nation while simultaneously treating it. As one of the largest global employers, and with one million patient contacts every 36 hours, the NHS can influence societies’ behaviours and attitudes towards resource and environmental issues.2 Therefore, the NHS has both a duty and a vested interest in acting on emissions and pollution.
Environmental Impact of Endoscopy
Endoscopy is a major contributor to the environmental footprint of health care, generating about 3.09 kg of waste per bed-day. It is the third highest emitting hospital department behind theatre and anaesthetics, then paediatrics and critical care.3 The high waste burden in high-throughput departments like endoscopy is created by multiple non-renewable waste streams and resource-heavy decontamination processes.4 The NHS has announced its commitment to achieve a net zero carbon footprint for emissions it controls directly by 2040, and net zero for those within its supply chain that it can indirectly influence by 2045.5
As part of a large NHS trust within the North of England, we service a population of approximately 500,000 people. Before the COVID-19 pandemic, our service delivered around 17,000 endoscopic procedures per year across five endoscopy units, and it was clear we needed to act.
In order to try and improve locally and participate in the trust-wide sustainability project, we created a team of Green Champions in the department. Their role is to motivate and encourage members of the team to embrace the recycling ethos, actively seek out new opportunities for recycling, and develop new ideas to replace single-use plastics.
We realised that we needed to introduce things gradually and therefore, set ourselves an initial 4-week goal to start with simple straightforward changes that would minimise resistance at an already challenging time. These changes included installing recycling bags in the treatment rooms (Figure 1); recycling instruments, such as biopsy forceps, snares, and spray catheters, into special bins where both metals and hard plastics are allowed; and exploring ideas with infection control to source recycled biodegradable absorption pads for patient use.
While these changes seem small, we expect them to have a huge impact across our five units. To assess the impact, we are carrying out an audit on the waste. The list of possible improvements, however, is much longer (Figure 2). With the commitment of our Green Champions at the frontline of relaying the message, we aim to create enthusiasm among our teams. We have also been actively liaising with the local county council recycling officer to improve understanding of the recycling process. This will include a visit to the recycling plant when possible following the COVID-19 pandemic. Close collaboration between our department and the recycling plant is essential to support our vision.
In our organisation, we are at the very start of our endoscopy recycling journey. I am sure we will meet lots of challenges along the way, but with support and commitment from our teams, we are confident that we will reach our goals. We can all make small changes that will add up if we work together, although the industry needs to make a difference too. We need to challenge manufacturers’ green credentials at every opportunity, and this will only be possible with a united voice from endoscopy units across the country.
Figure 1: Examples of single-use hard plastics used in the endoscopy unit that may be recycled
Figure 2: Opportunities for environmental change
- NHS England. NHS Net Zero—Call for evidence. 2020. https://www.engage.england.nhs.uk/survey/nhs-net-zero/ (accessed Feb 11, 2021).
- Royal College of Physicians. Breaking the fever: sustainability and climate change in the NHS. March 15, 2017. https://www.rcplondon.ac.uk/projects/outputs/breaking-fever-sustainability-and-climate-change-nhs (accessed Feb 11, 2021).
- Vaccari M, Tudor T, Perteghella A. Costs associated with the management of waste from healthcare facilities: an analysis at national and site level. Waste Manag Res 2018;36:39–47.
- Maurice JB, Siau K, Sebastian S, et al. Green endoscopy: a call for sustainability in the midst of COVID-19. Lancet Gastroenterol Hepatol 2020;5:636‒638. DOI: 10.1016/S2468-1253(20)30157-6.
Leigh Donnelly qualified as a nurse in 1993 and started her career in endoscopy in 1995. Over the years her interest in endoscopy has developed. She has been a clinical endoscopist and upper gastrointestinal nurse specialist for 18 years, and more recently I have become an endoscopy training and development lead. I am studying for a PhD examining the nurse endoscopist role in endoscopy training. Last year I was fortunate enough to be selected to become a committee member of the British Society of Gastroenterology Nurses Association.