A sustainable future for healthcare: the benefits of single-use endoscopes

Ambu is a Business Reporter client.

Healthcare is in the sights of government regulators and broader public opinion for its significant environmental footprint. If it were a country, healthcare would be the fifth largest emitter on the planet, and its every operational moment is under the carbon reduction microscope.

The pressures on hospitals to reach sustainability targets while still delivering high-quality care are growing, with everything from the procurement of personal protective equipment (PPE) to clinical equipment coming under intense scrutiny.

Finding ways to reduce that footprint across long, often complex supply chains is a prime focus for executives who now have tools such as low-carbon procurement interventions and system redesign available to mitigate climate change.

Improved management of energy resources, the eradication of single-use PPE and pressure on suppliers has generated sustainability gains across energy, water usage and waste management. But regulators and healthcare systems are demanding more: the UK’s National Health Service, for example, has committed to achieving a zero-carbon footprint by 2045, with green procurement strategies to identify and eliminate waste and poorly performing equipment.

Targeting single-use equipment seems an obvious route, but closer examination reveals that, for example, single-use endoscopes can help hospitals meet environmental goals. Studies have shown several metrics where single-use endoscopes show a lower environmental footprint when it comes to energy and water use and the amount of waste generated compared to the reprocessing of reusable endoscopes^[1].

“To some, it can feel counter-intuitive to choose single-use over reusable endoscopes. But single-use endoscopes can be significant in helping hospitals reach both efficiency and environmental targets,” says Casper Venbjerg Hansen, Global Sustainability Director at Ambu, market leaders in single-use endoscopy.

“Reusable endoscopes have a complex and energy-draining cleaning process with numerous steps that involves toxic chemicals that end up in waterways. The cleaning also consumes huge amounts of water – more water than in an average shower^[2]– while the process generates large amounts of waste from the PPE equipment staff must wear to handle the chemicals.

“These are important insights when considering which endoscopes to use.”

Adopting an efficient, safe and sustainable endoscope policy is critical to hospitals as the devices are involved in so many daily procedures. Research has shown it to be the third highest waste-generator in healthcare because it combines high caseloads, non-renewable materials and the resource-heavy decontamination process needed after every use of a reusable endoscope.

Reusable endoscopes account for vast amounts of waste with each reprocessing cycle generating the need for PPE and components such as brushes and sponges and their packaging that end up in incinerators or landfill. The scale of chemicals, water and energy use and waste products, which occur every time a reusable endoscope is reprocessed, is overlooked.

This wastage goes unseen by clinicians, who come into contact with endoscopes only during the procedures they perform, but the impact is witnessed by nurses tasked with the time-consuming cleaning process necessary for reusable endoscopes – time that may be better spent on clinical duties – and disposing of the PPE, cleaning equipment and chemicals.

“To achieve sustainability without impacting clinical standards or efficiency, we need to have a holistic view,” adds Hansen. “We need to assess every aspect and challenge perceptions. If you were asked whether coffee machine capsules or a French press coffee had the higher carbon footprint, you might naturally choose the capsules because of the aluminium packaging. But, when you consider the energy, water, transport, the larger amount of coffee needed, compared to the tightly controlled levels in each pod, and the ancillary costs, it is the French press method that has the much greater environmental footprint.”

The factors that contribute to single-use endoscopes as a sustainability choice range from clinical to operational: single-use endoscopes can reduce readmissions by 53 per cent while a study revealed that one single-use bronchoscope (Ambu® aScope™ 4 Broncho) produces slightly more than 1.5kg of CO2 (covering production, materials, use, disposal and incineration) to one reprocessing cycle of a reusable bronchoscope, which generates just under 3kg of CO2.

Ambu, which has disrupted endoscopy with single-use innovations that drive hospital and clinic performance, has responded by developing bio-handles made of bioplastics, which it will include in all endoscopes from 2025. It is also working towards having 95 per cent of new products PVC free by the end of 2025.

“We all have a role to play in sustainability and we are constantly challenging ourselves. Our first obligation is to patient safety,” says Hansen. “The flexibility of a medical device made from plastic ensures that it adapts to the human anatomy in a way that is gentle on the patient. Sustainable substitutes for plastic in medical devices are not currently available but it is in our DNA to problem-solve and innovate and one of our focus areas within sustainability is to find ways to make our products circular by focusing on bio-plastics and recycling programs.”

Ambu is operating take-back pilot partnerships in Germany and the UK, and a take-back and energy recovery partnership with Sharps Technology in the US, to further reduce its footprint and help its customers dispose of endoscopes in a responsible way after use.

Ambu has also partnered with Plastic Bank®, a social enterprise that works with local communities to collect ocean-bound plastics.

Ambu has engaged in this partnership while continuing to work towards a long-term goal of designing for recycling. The initiative has already collected the same amount of plastic in the Philippines and Indonesia that was used in all Ambu endoscope products sold in EMEA and Latin America during the period of the partnership.

Although its carbon reduction programme is a work in progress, Ambu has made significant strides in sustainability, and its innovative ethos has enabled the launch of three PVC-free products in 2021/22. Its next target is to introduce the use of bioplastics in parts of all endoscopes by 2025. Ambu is also a signatory to the Science Based Targets initiative, which commits it to reduce emissions in line with the Paris Agreement goals.

“We are straining every fibre to have sustainable practices throughout everything we do, and we share our customers’ desire and drive to greater sustainability,” says Hansen. “In doing so, it is important to look at the full picture and make choices that can both reduce carbon footprint and maintain high clinical performance.

“As the largest manufacture of single-use endoscopes, we at Ambu have an obligation to lead the way in how to lower the environmental impact of our products. And, as a Danish company, we find it natural to work towards sustainable solutions, as Denmark is one of the countries in the world that are at the forefront of the sustainability agenda.”

To find out more on how single-use endoscopes can benefit your hospital please visit ambu.com.

[1] *Tiphaine Boucheron, Eric Lechevallier, Bastien Gondran-Tellier, Floriane Michel, Cyrille Bastide, Nathalie Martin, and Michael Baboudjian. Cost and Environmental Impact of Disposable Flexible Cystoscopes Compared to Reusable Devices. Journal of Endourology. Oct 2022. 1317-1321.

*Birgitte Lilholt Sørensen, Henrik Grüttner. (2018) Comparative Study on Environmental Impacts of Reusable and Single-Use Bronchoscopes

*Michael Baboudjian, Benjamin Pradere, Nathalie Martin, Bastien Gondran-Tellier, Oriol Angerri, Tiphaine Boucheron, Cyrille Bastide, Esteban Emiliani, Vincent Misrai, Alberto Breda, Eric Lechevallier, Life Cycle Assessment of Reusable and Disposable Cystoscopes: A Path to Greener Urological Procedures, European Urology Focus, 2022.

[2] Australia: https://www.mdba.gov.au/sites/default/files/water-volumes-teacher-notes.pdf (55L per shower)

US: Alliance for Water Efficiency: https://home-water-works.org/indoor-use/showers