Cutting waste in bronchoscopy - a multicenter observational study in the German healthcare system

INTRODUCTION: Pulmonary endoscopy contributes substantially to medical waste generation. Previous studies have estimated the average waste per bronchoscopy at approximately 1.03 kg. However, scalable data are lacking. RESEARCH QUESTION: How much waste is generated by pulmonary procedures with reusable endoscopes (bronchoscopy and endobronchial ultrasound (EBUS)) at two 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 four 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 using health insurance data. RESULTS: 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. With regard to waste reduction, the use of reusable gowns as personal protective equipment could lead to a 61.5% reduction (p < 0.001). 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.