Sustainability is good medicine, iNovation speakers say

If healthcare were a country, it would have the 13th largest carbon footprint in the world. Medical waste accounts for 10% of greenhouse gas emissions in the United States and about 5% in the United Kingdom, Canada, and Japan, noted David F Chang MD at the inaugural iNovation programme Friday.

Much of that waste is unnecessary, said Dr Chang of the University of California–San Francisco, United States. He noted medical waste per phaco cataract surgery in the UK is 20 times that at the Aravind System in India, equal to driving a car 500 km in the UK versus 25 km at Aravind.

Much of the difference comes down to reuse of medical supplies and open vials of pharmaceuticals in India, where four patients are typically operated on in the same room at the same time. “In the United States, if I reused anything or did any of these things, I would be shut down because these are considered such dangerous practices that patient safety is at risk,” Dr Chang said.

Yet the endophthalmitis rate for 2 million consecutive patients at Aravind was 0.04%—identical to the overall rate for 8.5 million cases from the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) registry. And for 335,000 phaco cases using intracameral moxifloxacin, the Aravind rate was just 0.01%.

“We are wasting 20 times more to reach this demoralizing conclusion: the perception we are doing things to make things safer is not making any difference other than to create more waste and cost,” Dr Chang said.

PHYSICIAN OBLIGATION

It’s more than just an abstract concern, Dr Chang added. The World Health Organization has declared climate change the greatest threat to public health in the coming years. Physicians have a responsibility to do what they can to mitigate it.

By and large, surgeons are on board. In a survey of more than 1,000 ophthalmic surgeons, 10 times as many preferred a reusable instrument over single-use if the cost were the same. The overwhelming majority prefer greater reuse of supplies where appropriate, less wasteful packaging, and labelling the gives more discretion in what may be reused.

Industry has responded with initiatives to cut down the amount of packaging, reduce the bulk of items, and move to sustainable sourcing, said Thomas Bosshard, co-CEO, board member, and co-owner of Oertli in Switzerland.

But the overall trend has been in the other direction. It’s driven, in part, by regulations that require single use of many components, sometimes responding to identified infection risks, such as small gauge cannulas in the Netherlands. European regulations requiring tracking of medical devices throughout their life cycle are another factor adding to the expense of reusing them, industry representatives noted. Risk-averse hospital administrators also tend to favour disposable instruments.

WHAT SURGEONS CAN DO NOW

Dr Chang recommended that surgeons check out EyeSustain. org for detailed information on how they can work to reduce waste by changing clinic procedures. For example, drugs from multiuse packages can be used on multiple patients until the expiration date. Doing away with full body drapes, which COVID-19 studies on cross contamination show are unnecessary for cataract surgery, may be another option.

EyeSustain.org is sponsored by the ESCRS, ASCRS, and AAO. “It’s a good place to start,” said Sjoerd Elferink MD of the ESCRS Young Ophthalmologists Green Group.