BLOG: The enormous potential of small actions
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“Nobody made a greater mistake than he who did nothing because he could do only a little.”
– Edmund Burke, Irish philosopher
When I first entered the medical profession more than 30 years ago, I was taken by the amount of trash that was produced in the emergency department where I volunteered.
Rotating into the operating room, the amount of trash was even more shocking. Many of us probably had similar reactions in our earliest exposure to medicine, but we numb to the dogma that encasing a sterile treasure in too much packaging must make it somehow better for the patient. The result has been a catastrophic growth of waste.
A study published in Healthcare suggested that the global medical community produces about 6 million tons of plastic waste annually. That’s the equivalent weight of 32,000 Boeing 747s. Picture that. A stadium where each “seat” is filled by one of the largest airplanes ever built — all going into the trash. Part of that behemoth of waste makes up the 2 million tons of plastic waste that enters the oceans annually, according to the United Nations Environment Program.
When a problem seems bigger than us, it’s human nature to dismiss responsibility for solving it. Yet much impact has already come from individuals and their institutions making systemic change to reduce waste. In eye care, EyeSustain is a group of volunteer physicians, medical students and staff members who have built a growing library of resources at EyeSustain.org. Designed for ophthalmology, the ideas are portable to other medical specialties. One topic is reducing instruments in surgical trays, eliminating those disposable syringes, blades and drapes that are needed only occasionally. Another explores how infection prevention measures in operating rooms can be at odds with sustainability while providing no medical benefit.
EyeSustain has also published three position papers that have been endorsed by multiple global eye care societies. One argues against the wasteful, expensive practice of throwing away a bottle of eye drops after use on a single patient. We all know that a bottle of drops can be used in an aseptic fashion for many patients until it’s empty or expired. Despite that, across the U.S., some misinformed regulators have erroneously warned facilities that drops are for single patient use, despite any evidence or formal regulation that supports this. The position paper enables practitioners and staff to push back against such wasteful “policies.”
EyeSustain’s other position papers address instrument sterilization as well as the age-old mandate for manufacturers to package each medical device with a large paper instructions for use (IFU) printed in many languages. This paper argues with strong evidence, and full support from the device industry, that a small QR code on the device packaging could replace the paper IFU and save many forests, while saving on production cost and shipping emissions.
Most of all, EyeSustain encourages each practice and facility to adopt a pledge to educate surgeons and staff, regularly evaluate surgical packs, use multidose bottles of drops, assess the need for full body surgical draping, consider the adoption of multiple-use instruments where possible, explore alcohol-based surgical scrubs and institute recycling strategies.
The best ideas for sustainability come from clever local surgeons and staff members — getting rid of disposable coffee cups in favor of rinsable mugs, composting food waste, recycling office paper and consciously monitoring what needs to be opened for a case.
In the culinary world, Anne-Marie Bonneau, known as the Zero-Waste Chef, famously said, “We don’t need a handful of people doing zero waste perfectly. We need millions of people doing it imperfectly.” That’s a call to action that all of us in health care should heed.
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References:
- Electronic IFU. https://eyesustain.org/events/electronic-ifu. Accessed Feb. 27, 2024.
- Infection prevention measures in ORs can be at odds with sustainability. https://eyesustain.org/resource-library/infection-prevention-measures-in-ors-can-be-at-odds-with-sustainability. Accessed Feb. 27, 2024.
- Janik-Karpinska E, et al. Healthcare (Basel). 2023;doi:10.3390/healthcare11020242.
- Marine litter vital graphics. https://www.grida.no/publications/60. Published July 6, 2016. Accessed Feb. 27, 2024.
- Reducing instruments in a vitrectomy surgical tray: cost savings and results from a major academic hospital. https://eyesustain.org/resource-library/reducing-instruments-in-a-vitrectomy-surgical-tray. Accessed Feb. 27, 2024.
- Reducing topical drug waste in ophthalmic surgery (issued 2022). https://eyesustain.org/events/reducing-topical-drug-waste. Accessed Feb. 27, 2024.
- The surgical facility pledge. https://eyesustain.org/facility-pledge. Accessed Feb. 27, 2024.
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