Cutting Waste in Bronchoscopy: A Multicenter Observational Study in the German Health Care System.

BACKGROUND

Pulmonary endoscopy contributes substantially to medical waste generation. Previous studies have estimated the average waste per bronchoscopy at approximately 1.03 kg. Scalable data are lacking, however.

RESEARCH QUESTION: How much waste is generated by pulmonary procedures with reusable endoscopes (bronchoscopy and endobronchial ultrasound [EBUS]) at 2 German tertiary care centers, what is the estimated national impact, and which strategies can be identified for waste reduction?

STUDY DESIGN AND

METHODS

In a prospective, multicenter observational study conducted over 4 weeks per center, waste from 107 procedures in 79 patients was collected, categorized, and weighed. The proportion of recyclable materials was determined. National waste production was extrapolated by using health insurance data.

RESULTS

On average, 1,479.7 g of waste was generated per patient. Standalone bronchoscopy produced 1,276.5 g, whereas combined bronchoscopy plus EBUS generated 1,849.7 g of waste. Extrapolated for Germany's pulmonary endoscopies, this corresponds to 551.6 tons of waste per year, equivalent to 270 tons of CO2 emissions. Of the total waste, 74.8% originated in the examination room, 7.8% from suction bags, and 17.4% from reprocessing and recovery areas. Regarding waste reduction, the use of reusable gowns as personal protective equipment could lead to a 61.5% reduction (P < .001). Overall, 28.7% of the waste was potentially recyclable. Using single-use endoscopes instead might have increased the waste per procedure, even though reprocessing waste would have been minimized. An additional 111.8 g of residual waste (16.0%), 15.1 g of paper (13.0%), and 1.1 g of plastic (0.5%) would have been produced per procedure.

INTERPRETATION: Pulmonary endoscopies generate considerable amounts of waste. Strategies such as procedural bundling, reusable protective equipment, and recycling can reduce the environmental footprint, whereas the use of disposable bronchoscopes further increases the waste burden.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT05921136; URL: www.

CLINICALTRIALS: gov.