Earlier this year in Dublin, the European Society of Gastrointestinal Endoscopy (ESGE) held its annual conference. One of ESGE’s key focus points was “to raise awareness of the ecological footprint of gastrointestinal endoscopy and provide guidance to reduce its environmental impact.” Similarly, in May, the Digestive Disease Week conference in Chicago had a theme of sustainability.
Cook Medical, a medical device company based out of Indiana, attended both conferences. In addition to showing our medical devices, we also designed our booths to fit with the environmental themes. The booth for our company at both conferences was made from recycled aluminum, recycled carpet and padding, sustainably sourced laminates and eco-friendly adhesives. Instead of handing out water bottles like we did last year, we had a water container and offered compostable cups. We even considered the lighting: all lights and screens were LED for lower energy consumption.
Many other companies at these conferences also had booths that were themed with earth-friendly messages and materials. However, compostable cups don’t solve the real problem. We are still left to address a serious sustainability issue that will last far beyond the conferences: the high amount of waste that comes from the medical device industry.
According to the American Medical Association, hospitals in the United States throw away 6 million tons of waste annually, and most of that is personal protective equipment or medical devices and packaging. Most of the waste is improperly disposed of, which hurts the environment. When medical waste is not properly taken care of, it can leech heavy metals and harmful chemicals into the soil and groundwater. Waste can also spread microorganisms and drug-resistant bacteria.
Gastrointestinal and endoscopy specialties, in particular, produce more waste than almost any other medical specialty. According to the American Gastroenterological Association, endoscopy is the third largest generator of medical waste in a hospital (2 kg total waste per procedure), and most of it ends up in landfills. It’s not just bad for the environment—it’s expensive, too. The estimated cost of waste in the US healthcare system is between $760 billion and $935 billion. If we could prevent medical device waste, the environment would benefit, and hospitals could save money, too.
To combat these high rates of waste, many organizations—including the two conferences mentioned earlier—are exploring ideas such as reusing medical devices or recycling used devices. For example, ESGE-ESGENA announced several main statements regarding the environmental footprint of endoscopy. Some of the guidelines are:
- Adherence to guidelines and implementation of audit strategies on the appropriateness of GI endoscopy to avoid the environmental impact of unnecessary procedures
- Implementing reduce, reuse, and recycle programs in the GI endoscopy unit
- Reassessing and reducing the environmental and economic impact of single-use GI endoscopic devices
These initiatives are controversial ones. One of the challenges the medical device industry faces is the move from multi-use devices to single-use plastic ones. One of the biggest reasons is that the disposable devices help decrease the risk of infection transmission because there is no reuse between patients. If a physician uses a duodenoscope in one patient’s intestines, doesn’t clean it properly, and then uses it in another patient, there is a very low, but potentially deadly, chance of infection. Yes, there’s more waste with single-use devices, but it’s potentially safer for patients.
Another factor is the financial cost. Single-use devices are expensive, but so is treating a patient who got infected by a reusable device. In a study on reusable endoscopes published in Techniques and Innovations in Gastrointestinal Endoscopy, researchers estimated that hospitals would spend about $500,000 per patientwho is hospitalized for infection from a reusable duodenoscope. Additionally, hospitals would incur expenses for processing and sterilizing the reusable devices. However, switching completely to single-use, disposable duodenoscope would cost about $1 billion annually in the US, and it would also come at a high cost to the environment and to future generations.
So do we prioritize the safety of patients by using high-waste single use devices? Or do we protect the planet and risk harming patients? It’s a tricky situation. At Cook, we’re wondering if perhaps the industry is asking the wrong questions. We’ve started to approach this a different way. What if, rather than just recycling waste, we looked at the medical system holistically to find ways to prevent waste from being created in the first place?
Think Bigger and Longer-Term
Cook also cares about the environment as well as patients, which is why we try to think in broader terms of the healthcare system as a whole. Finding solutions to help our planet is an urgent need, so we’ve tried some longer-term initiatives that help the whole supply chain be more eco-friendly, rather than just the end product having less packaging.
About 71% of the health care carbon footprint comes from supply chain issues. This is the biggest and easiest area for Cook—and medical device companies worldwide—to start preventing waste from happening in the first place. In fact, “medical waste reverse supply chain” is now a philosophy that some countries are starting to adopt, where hospital systems consider how to more efficiently use products before waste is made, rather than simply trying to manage the waste created afterward.
Cook has made efforts to streamline supply chain interactions with many contracts. In the USA for example, we contract with Vizient, a group purchasing organization, to make it easier for hospital systems to order the products they need efficiently. We also just won our third contract with the US Department of Veterans Affairs. These contracts are both economically and environmentally efficient. Contracts are more efficient for shipping and transporting of the medical devices from fewer suppliers, and contracts prevent over-ordering so fewer devices are wasted.
In 2019, our manufacturing sites in Denmark and Ireland were certified to the ISO 14001 Environmental Management standard. Early in 2022, the Cook Medical facility in Winston-Salem, North Carolina, was also certified to ISO 14001. These standards help us run our facilities efficiently and prevent waste from being created.
We also want to cut down on energy waste while we make our devices. For example, in September 2022, Cook completed a massive array of about 3,000 solar panels on the roofs of the buildings at our headquarters in Indiana, USA. The solar panels will offset more than 1,000 metric tons of CO2 in the first year of use—the equivalent of the amount of CO2 generated from burning six rail cars’ worth of coal. We also installed solar panels at our facility in Brisbane, Australia. The panels there save 315 metric tons of carbon a year.
A Holistic Approach
Reducing medical device waste is an urgent issue. However, it’s not a simple problem that can be fixed with a single change, such as using less packaging. Reducing waste in the medical field needs to be part of a holistic approach to sustainability. For lasting change to happen in the GI field, the whole medical device industry needs to consider big-picture issues like energy consumption, integration with healthcare systems, supply chain inefficiencies, designing products from the outset with sustainability in mind and more.
Some companies shy away from these initiatives. It can be costly to make significant procedural changes. But at Cook, we believe that if our communities aren’t healthy, we aren’t healthy. Companies play a vital role in building strong, healthy, and sustainable communities for the future. We can be a successful business, keep patients safe, and make changes that take care of the planet and are responsible with the materials we use—all at the same time.
Environmental sustainability is critical for the planet, but it’s good for business too. Today, more than 60% of consumers in the U.S. want businesses to improve societal and environmental issues. Conversely, ignoring sustainability efforts could easily result in financial penalties and a negative brand reputation.
Cook doesn’t see protecting patient lives as being at odds with our commitment to the environment. Our balances aren’t perfect yet, but we are thinking long-term when it comes to company-wide initiatives. We encourage other companies in our industry to indeed take swift action on cutting down medical device waste, but to do so in a way that encompasses a shift in mindset as well as in practice.