Sustainable IR

Steps to creating an eco-friendly practice

The health care system in the United States significantly contributes to the country’s greenhouse gas (GHG) emissions (10%), electricity consumption (73 billion kWh, 9%) and solid waste (1.54 billion kg, 1%).1,2 Due to the environmental impact of GHG emissions, there have been various calls for the health care industry to reduce its carbon footprint.

Modern imaging equipment requires a large amount of energy consumption and, along with the extensive use of single-use, disposable products, interventional radiology itself contributes a great deal of GHG emissions, electricity consumption and solid waste. This has been widely acknowledged in the literature and many individual IR divisions are already taking steps to reduce their carbon footprint by identifying common practice patterns that have significant environmental impacts.

Data from a recent study estimated that one IR department at a large center emitted approximately 23,500 kg of carbon dioxide equivalent (CO2e) gases over 5 days—an average of 243 Kg CO2e per procedure.3 The most significant carbon emissions came from indoor climate control systems (49%), followed by production and delivery of disposables (from warehouse to the hospital; 41%), electricity for equipment and lighting (4%), waste disposal (2%), and the use of gas anesthetics (<1%). For perspective, it would take 389 trees 10 years to offset the single IR division’s 5-day carbon emission.4

Energy use

Interestingly, the majority of the electricity and gas used to power the clinical control system happens outside scheduled working hours, when the suites were either unoccupied or rarely used.3 Thus, electricity use in IR can be reduced by modifying the current use of climate control systems and by switching off the imaging equipment, computers and lighting when they are not in use, which would have minimal if any impact on clinical care but a net gain on reducing emissions and energy costs.5 The climate control system use can be modified by allowing it to drift within a wide range of temperatures (instead of maintaining the optimum temperature at all times) when the suite is not in use.

Products and disposables

Transporting medical supplies, which often involves international or interstate shipping of individually boxed items, has also been shown to contribute significantly to GHG production. If possible, using locally produced supplies or purchasing supplies that are housed nearby and provide batch shipping can significantly reduce the environmental impact.

An assessment of the procedural waste collected in the IR suite showed that approximately 55% of the total weight of the products used in IR contribute to waste and are not utilized during the actual procedure, and 76% of the waste generated from these products is recyclable.6 However, much of it is not recycled due to improper sorting and disposal.7 This can be alleviated by educating staff, procuring recycling bins and instituting facility-wide recycling policies.

Waste segregation strategies

Divert noninfectious waste during the back table setup.

  • Have a large solid waste container and recycling container.
  • Line the red regulated medical waste container with a clear bag to capture the noninfectious waste and set it aside by tying it off before the procedure starts to avoid contamination.

Segregate noninfectious waste after procedures during cleanup.

  • Noncontaminated surgical wastes and drapes, remaining packaging, and sterile wrap can be removed by placing in clean plastic bags similar to pre-procedure waste collection.

Segregate noninfectious waste during the procedure.

  • Set up alternate containers for solid waste and recycling along with the regulated medical waste container to capture the noninfectious waste during the actual procedure.
  • This step needs a high level of awareness and commitment from everyone, as placement of a single infectious waste in the wrong container can cause problems with regulatory compliance.

Every item used during an IR procedure has about two waste packages, and some have as many as five.8 It is worth questioning if medical companies can redesign the packages to remove layers that don’t contribute to product protection or sterility. The paper instruction booklets included in all disposables can be replaced with digital instructions accessed online, possibly via a QR-code. And commonly used kits such as central lines or enteric feeding tubes can be assessed regularly to identify which components aren’t used during procedures and only contribute to waste. Since medical device and consumable product packing isn’t governed by an international standard, there is no reason not to take the steps needed to create sterile packaging that produces less medical waste.

It is critical to understand how our clinical practice affects the planet’s ecosystem. As leaders in medicine and society, we are adequately positioned to spearhead initiatives around sustainable health care practices. Creating a sustainable IR practice requires multidisciplinary collaboration between health care personnel and hospital management, staff education, appropriate guidance and leadership, and the development and use of environment-friendly technologies.

How to produce less waste

  1. Sort waste generated during procedures correctly for more effective recycling (solid waste, recyclable waste, regulated medical waste),
  2. Purchase products that are likely to have lower GHG emissions or are produced sustainably.
  3. Lobby medical device and supply companies to reduce their packaging footprints.
  4. Shift to using supplies that can be reprocessed for reuse, rather than relying on single-use, disposable products.

References

  1. Eckelman MJ, Huang K, Lagasse R, Senay E, Dubrow R, Sherman JD. Health care pollution and public health damage in The United States: An update: Study examines health care pollution and public health damage in the United States. Health Affairs. 2020;39(12):2071–2079. Doi:10.1377/hlthaff.2020.01247.
  2. Chung JW, Meltzer DO. Estimate of the carbon footprint of the US health care sector. JAMA. 2009;302(18):1970–1972. doi:10.1001/jama.2009.1610.
  3. Chua ALB, Amin R, Zhang J, Thiel CL, Gross JS. The environmental impact of interventional radiology: An evaluation of greenhouse gas emissions from an academic interventional radiology practice. JVIR. 2021;32(6):907–915.e3. doi:10.1016/j.jvir.2021.03.531.
  4. United States Environmental Protection Agency EPA. Greenhouse Gas Equivalencies Calculator. Greenhouse Gas Equivalencies Calculator. epa.gov/energy/greenhouse-gas-equivalencies-calculator.
  5. Chawla A, Chinchure D, Marchinkow LO, Munk PL, Peh WCG. Greening the radiology department: Not a big mountain to climb. Can Assoc Radiol J. 2017;68(3):234–236. Doi:10.1016/j.carj.2016.10.009.
  6. Clements W, Chow J, Corish C, Tang VD, Houlihan C. Assessing the burden of packaging and recyclability of single-use products in interventional radiology. Cardiovasc Intervent Radiol. 2020;43(6):910–915. Doi:10.1007/s00270-020-02427-3.
  7. Blessy J, James J, Kalarikkal N, Thomas S. Recycling of medical plastics. Advanced Industrial and Engineering Polymer Research. 2021;4(3):199–208. Doi:10.1016/j.aiepr.2021.06.003.
  8. Shum PL, Kok HK, Maingard J, et al. Environmental sustainability in neurointerventional procedures: A waste audit. J Neurointerv Surg. 2020;12(11):1053-1057. doi:10.1136/neurintsurg-2020-016380.