Author: Ishani Majmudar
Medical waste is rising tremendously each year, and its implications are not slight. Medical waste is a broad term used to describe any waste products generated at healthcare facilities and includes everything ranging from the disposal of small needles to the energy consumption of radiologic scans. Reducing waste can save money for practices and operating rooms, and benefit the environment.
The breadth of services provided by modern day medicine is profound. Innovative surgeries, novel pharmaceuticals, and state of the art technology are just a few of the driving forces that have aided the delivery of exceptional care to patients across all specialties. These advancements, however, come with a cost – both financial and environmental. During the COVID-19 pandemic, healthcare facilities gravitated towards disposable medical products to minimize the transmission of infection. A 2022 review paper reports that the total biomedical waste in the United States during the pandemic was upwards of 16,000 tons per day.1
Unfortunately, the use of disposables persists long after COVID-19 has abated. Excess medical waste exists within all specialties, though the degree of the problem varies. In my field of interest, ophthalmology, sources of unnecessary medical waste include single use eyedrops, oversized surgical drapes in the operating room, the unnecessary use of anesthetic gases during cataract surgeries, and single-use equipment. Organizations such as EyeSustain and My Green Doctor are educating clinicians and practice managers on ways to reduce medical waste and are promoting research on this topic.
My personal advocacy project is the problem of single use eyedrops. This example typifies our industry’s medical waste crisis and highlights some of the challenges we face and some has tangible solutions.
Dilating and anesthetic eye drops are used routinely to treat patients in most ophthalmology clinics. The standard of care worldwide in clinics is to use multidose eyedrop bottles — meaning there is enough medicine one bottle to treat many patients. In the operating room, however, a wasteful practice has evolved to discard eyedrop bottles after just one use. The rationale for this practice is to minimize cross-contamination in a sterile environment, though there is scant research to support this contention.2
The medical literature describes the financial and environmental benefits of choosing multidose eyedrops. A 2010 research study found that treating two patients per bottle instead of one would decrease plastic waste by approximately 12.69 tons in the United Kingdom each year.2 Beyond that, hundreds of thousands of dollars are being wasted each year due to unused pharmaceutical products; multiuse drops could save each large U.S. hospital upwards of $240,000 over 5 years.3
“Each U.S. hospital could save $240,000 per year.”
The Aravind Eye Care System is a network of sophisticated eye hospitals and clinics in India. A study at their Pondicherry hospital assessed the safety of using multidose drop bottles. Video recordings were taken as providers administered perioperative routine eyedrops to patients and the eyedrop bottle tips were cultured to assess microbial growth. The results of this study demonstrated that multidose eyedrops are a safe and plausible alternative to single dose eyedrop bottles. Additionally, the post-operative infection rates reported at Aravind were found to be lower than the rates in the United States, which employs a single-dose policy. 4
Changing to multiuse bottles will be challenging. Single use has become the custom for most clinicians and managers, just as disposable products have become prevalent across the medical supply chain. The use of medications in U.S. operating rooms is regulated by the individual states; changing to multi-dose eyedrops will require administrative and legislative advocacy by eye specialists in every state and country. In 2022, the American Academy of Ophthalmology created a legislative template for the “Topical Medical Waste Reduction Act” that would allow multiuse bottles for eye drop administration in ophthalmic surgery. This template is based on a 2021 Illinois law that allowed patients to take home any topically applied medications that were used during surgery if the patient needed it for postoperative care. Clinicians and medical professional societies can use this template to help implement much-needed change.
There are other steps that clinicians can in their practices and hospitals. First, begin asking questions and encouraging conversations about what you and your team can do to make your daily activities more environmentally sustainable. One way to begin is to ask your practice manager to take advantage of the free resources at EyeSustain and My Green Doctor.
Once you have begun adopting effective sustainability practices into your own clinic, consider working within your professional societies to work for change. The product manufacturers and vendors will need to be active partners as well. The unity of many voices and key stakeholders will be what creates lasting impacts!
Single-use eye drops in ophthalmology operating rooms is just one example of the waste crisis in healthcare. Concerned eye specialists have rolled up their sleeves to study the health, financial, and environmental implications, and have found creative medical and legislative solutions. Let this be your call to action!
References:
- Ngoc SV, Nguyen MA, Nguyen TL, Thi HV, Dao TL, Bui TMP, Hoang VT, Chu DT. COVID-19 and environmental health: A systematic analysis for the global burden of biomedical waste by this epidemic. Case Stud Chem Environ Eng. 2022 Dec;6:100245. doi: 10.1016/j.cscee.2022.100245. Epub 2022 Aug 10. PMID: 37520922; PMCID: PMC9364663.
- Somner, J., Cavanagh, D., Wong, K. et al. The precautionary principle: what is the risk of reusing disposable drops in routine ophthalmology consultations and what are the costs of reducing this risk to zero?. Eye 24, 361–363 (2010). https://doi.org/10.1038/eye.2009.129
- Berkowitz, S. T., Finn, A., Sternberg, P., Jr, & Patel, S. (2022). Potential Cost Savings Associated with a Multiuse Preoperative and Preinjection Eyedrop Protocol. Ophthalmology, 129(11), 1305–1312. https://doi.org/10.1016/j.ophtha.2022.06.023
- Wu, A. M., Kumar, P., Stein, J. D., Venkatesh, R., Zhou, Y., & Robin, A. L. (2021). A Videographic Evaluation of Eyedrop Administration by Ophthalmic Technicians. Ophthalmology, 128(5), 796–798. https://doi.org/10.1016/j.ophtha.2020.09.029
About the author
Ishani Majmudar is a Contributing Editor for My Green Doctor. She is a graduate of Northwestern University and is a rising 4th year medical student at the Feinberg School of Medicine at Northwestern University in Chicago. Her email address is [email protected].
Acknowledgement: Thank you to Dr. David J. Palmer, MD, for his support and leadership on this topic.
