Single-use accessories and endoscopes in the era of sustainability and climate change-A balancing act

APAGE Position Statements on Green and Sustainability in Gastroenterology, Hepatology, and Gastrointestinal Endoscopy

BACKGROUND AND AIM

The APAGE Position Statements aimed to provide guidance to healthcare practitioners on clinical practices aligned with climate sustainability.

METHODS

A taskforce convened by APAGE proposed provisional statements. Twenty-two gastroenterologists from the Asian Pacific region participated in online voting and consensus was assessed through an anonymized and iterative Delphi process.

RESULTS

There were five sections that addressed the rationale for climate action, the importance of adopting principles of waste management, clinical practice, gastrointestinal endoscopy, and issues related to advocacy and research. Sixteen statements achieved consensus and included the following: 1. APAGE recommends adopting prompt measures to reduce the carbon footprint of clinical practice due to the importance of climate action and its health cobenefits. 5. APAGE recommends adherence to professional clinical guidelines to optimize clinical care delivery in gastroenterology and hepatology to avoid the environmental impact of unnecessary procedures and tests. 8. APAGE recommends an emphasis on health promotion, disease prevention, and appropriate screening and surveillance, when resources are available, to reduce the environmental impact of managing more advanced diseases that require more intensive resources. 12. APAGE recommends that technological advances in endoscopic imaging and artificial intelligence, when available, be used to improve the precision of endoscopic diagnosis to reduce the risk of missed lesions and need for unnecessary biopsies. 13. APAGE recommends against the routine use of single-use endoscopes.

CONCLUSION

The position statements provide guidance to healthcare practitioners on clinical practices in gastroenterology, hepatology, and endoscopy that promote climate sustainability.

Eco-gastroenterology in Inflammatory Bowel Disease Treatment: A Call for Sustainable Healthcare

Gastroenterology significantly impacts the environment, contributing to medical waste. Adopting green practices like noninvasive diagnostics, telemedicine, and home monitoring can reduce the carbon footprint while maintaining effective inflammatory bowel disease patient care. Healthcare workers must integrate environmental considerations into their practices.

Greening Infection Prevention and Control: Multifaceted Approaches to a Sustainable Future

Infection prevention and control, or IP&C, is a critical stakeholder in advancing environmental sustainability in health care. IP&C activities seek to ensure safety of processes in health care from an infection perspective, but how these are performed can drive substantial waste and pollution. There are certain IP&C measures that can, without compromising safety or efficiency, be adapted to more environmentally friendly practices and have a high impact benefit to sustainability without affecting patient outcomes. Moreover, IP&C practice stands to be significantly altered by climate change and pollution. Here, we describe the complex interdependence between sustainability, climate change, and IP&C, and opportunities for IP&C to be at the leading edge of optimizing healthcare's environmental footprint.

Focus on patient perspectives in climate action policies for healthcare. A German survey analysis on what patients are willing to do

Background

The healthcare sector, while dedicated to improving health, paradoxically contributes significantly to global carbon emissions, accounting for approximately 4.9% of global emissions. Despite growing public concern about climate change, few studies have explored patients' awareness and attitudes toward the environmental impact of healthcare. This study aims to assess patients' perspectives on climate change and the sustainability of healthcare practices.

Methods

A cross-sectional survey was conducted at Ludwig-Maximilians-University (LMU) Hospital in Munich, Germany. Patients were invited to participate in a voluntary, anonymous online survey via strategically placed QR codes throughout the hospital. The survey explored patients' demographic information, environmental awareness, attitudes toward climate-friendly practices in healthcare, and willingness to support sustainable initiatives. Descriptive statistics and regression analyses were used to analyze the data.

Results

A total of 399 patients completed the survey (87% completion rate). The majority of respondents (92.3%) were aware of climate change, and 82.7% reported prioritizing climate-friendly practices in their personal lives. However, 55.9% of respondents were unaware of the healthcare system's contribution to carbon emissions, and only 18.3% knew about hospitals' climate impact. Despite this, 88.2% of respondents supported environmentally friendly initiatives in hospitals, and 86.5% were open to sustainable alternatives, provided that quality standards were maintained. Participants expressed significant interest in knowing the environmental impact of their treatments, with 63.2% in favor of a Nutri-Score-like system that would display the carbon footprint of medical procedures. Among those, 54.4% indicated that such a system would influence their choice of treatment. Similarly, 62.2% of respondents were interested in knowing the environmental impact of their medications, with 65% reporting that this information would affect their medication choices. A notable proportion of patients (66.2%) indicated willingness to support sustainable healthcare through shorter hospital stays and increased follow-up visits, while 35.8% were open to paying a CO2 compensation fee for their treatments. However, 81% were unwilling to pay higher insurance premiums to support environmentally friendly practices in hospitals. Regression analyses revealed that older age groups and having children were positively associated with environmental awareness (p < 0.05). However, factors such as gender, education level, relationship status, and illness severity did not significantly impact environmental attitudes. There was a significant correlation between patients' environmental friendliness and their readiness to take climate-protective actions (p < 0.001).

Conclusion

The study highlights a gap between patients' environmental awareness and their knowledge of healthcare's carbon footprint. While patients are generally supportive of sustainable practices in healthcare, their willingness to act diminishes when personal costs or discomfort are involved. A coordinated approach involving policy changes, patient education, and market innovations is essential to promote sustainable practices in healthcare without compromising patient care quality. Further research is needed to explore strategies for bridging the gap between environmental awareness and action in healthcare settings.

Climate Sustainability as a Catalyst for Quality and Excellence in Gastrointestinal Endoscopy: A Narrative Review

The significant contribution of greenhouse gas (GHG) emissions to global warming and the resultant negative impact on health is well established. Within the hospital setting, the endoscopy center has been ranked third-after the operating theater complex and intensive care unit-in terms of the volume of hazardous medical waste generated. Such regulated medical waste cannot be recycled, and the disposal process results in higher costs and a larger carbon footprint. There have been clarion calls to reduce the number of endoscopic procedures as a means of reducing GHG emissions. Previous studies have demonstrated the carbon footprint of inappropriate endoscopic procedures. However, endoscopy is an important diagnostic and therapeutic tool that has been shown to be cost-effective. A focus simply on reduction in procedural case volume alone raises the unintended consequences of inequitable access to endoscopy for those in need. A more nuanced approach that is aligned with the innate sense of healthcare professional aspirations and pride, in terms of seeking quality and clinical excellence, should be considered. An evidence-based approach, with a focus on quality and efficiency, as well as appropriate and timely use of new technology, will serve as a catalyst for positive behavioral change toward quality procedures and excellence. This will improve patient satisfaction, increase professional expertise and pride, and reduce carbon footprint through minimization of inappropriate and avoidable repeat procedures.

Ecogastroenterology: cultivating sustainable clinical excellence in an environmentally conscious landscape

Gastrointestinal practices, especially endoscopy, have a substantial environmental impact, marked by notable greenhouse gas emissions and waste generation. As the world struggles with climate change, there emerges a pressing need to re-evaluate and reform the environmental footprint within gastrointestinal medicine. The challenge lies in finding a harmonious balance between ensuring clinical effectiveness and upholding environmental responsibility. This task involves recognising that the most significant reduction in the carbon footprint of endoscopy is achieved by avoiding unnecessary procedures; addressing the use of single-use endoscopes and accessories; and extending beyond the procedural suites to include clinics, virtual care, and conferences, among other aspects of gastrointestinal practice. The emerging digital realm in health care is crucial, given the potential environmental advantages of virtual gastroenterological care. Through an in-depth analysis, this review presents a path towards sustainable gastrointestinal practices, emphasising integrated strategies that prioritise both patient care and environmental stewardship.

Healthcare in the era of climate change and the need for environmental sustainability

ABSTRACT

Climate change is an existential threat to humanity. While the healthcare sector must manage the health-related consequences of climate change, it is a significant contributor to greenhouse gas emissions, responsible for up to 4.6% of global emission, aggravating global warming. Within the hospital environment, the three largest contributors to greenhouse gas emissions are the operating theatre, intensive care unit and gastrointestinal endoscopy. Knowledge of the health-related burden of climate change and the potential transformative health benefits of climate action is important to all health professionals, as they play crucial roles in effecting change. This article summarises the available literature on the impact of healthcare on climate change and efforts in mitigation, focusing on the intrinsic differences and similarities across the operating theatre complex, intensive care unit and gastrointestinal endoscopy unit. It also discusses strategies to reduce carbon footprint.