Combining urine antigen tests could significantly reduce waste, CO2 emissions
Key takeaways:
- Combining urine antigen tests resulted in a reduction of 77.74% in plastic waste and 91.43% in paper waste.
- The switch to combined tests also resulted in a 79.34% reduction in CO2 emissions.
ORLANDO — Combining urine antigen tests for Streptococcus pneumoniae and Legionella pneumophilia could result in significantly less plastic and paper waste, as well as fewer carbon dioxide emissions, researchers reported at SHEA Spring.
“Our research team was inspired to quantify emissions associated with common tests ordered at our institution,” Rahee M. Nerurkar, MD, a founding member of the Environmental Advocacy Committee at Montefiore Einstein, told Healio. “We know that the health care sector is responsible for almost 10% of U.S. emissions, and the majority of emissions come from the supply chain associated with the manufacturing and disposal of health care items. If we can quantify emissions, it’s the first step to understanding how to reduce our carbon footprint.”
Nerurkar added that their institution had recently switched from two separate tests for S. pneumoniae and L. pneumophilia urine antigens to a single, combined test. This led the team to measure emissions associated with the waste created from the separate tests vs. projected waste from the combined test.
“Our hope is that by quantifying the emissions diverted by this lab workflow change, we might be able to inspire a similar change at other institutions and also encourage changes to other commonly ordered tests or medications,” Nerurkar said.
To measure these emissions, each test kit component was weighed and converted to carbon dioxide (CO2) emission equivalents using the U.S. Environmental Protection Agency greenhouse gas equivalencies calculators. Then, using data from the previous 12 months and applying similar future testing patterns, the researchers estimated the possible emissions reduction based on the combined testing strategy.
Between January 2023 and November 2024, 13,906 urine L. pneumophilia tests and 12,796 urine S. pneumoniae tests were performed. According to the study, separate testing kits for these generated 218.2 kg of plastic waste and 749.1 kg of paper waste.
The projected plastic and paper waste from January 2025 to November 2026 using the combined tests was an estimated 48.5 kg and 64.2 kg, respectively, yielding a 77.74% reduction in plastic waste and 91.43% in paper waste vs. the individual tests.
Nerurkar explained that these numbers were then converted into CO2 equivalents using Greenhealth’s Health Care Emissions Impact Calculator. This showed that 4.34 CO2 equivalents were projected to be saved by using these combined tests, representing a 79.34% reduction in emissions.
“[This is] equivalent to charging 340 smartphones or using 11 gallons of gasoline to fuel a car,” Nerurkar said.
Based on these findings, Nerurkar said that hospitals should implement workflow changes that divert emissions, especially for commonly ordered tests.
“It is helpful to focus on a change that does not affect patient care or clinician workflow, since these changes are more difficult to implement,” Nerurkar said. “Working with a highly motivated, interdisciplinary team made this project more achievable.”
For more information:
Rahee M. Nerurkar, MD, can be contacted through Anshel Kenkare, MD, at akenkare@montefiore.org.
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Nori P, et al. Abstract 391. Presented at: SHEA Spring; April 27-30, 2025; Orlando.
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