SUMU-Endo: Single-use versus Multiple-use Endoscopes in gastroenterology: multi methods analysis to balancing infection control and environmental impact

The NHS has an ambition to be the first global healthcare system to deliver a net zero target by 2040. If we are to achieve this, then some current practices in medicine may or may not need to change to embrace sustainability.

Conversely, proposed new practices need to have their sustainability assessed before they are introduced, One example is the proposed move to single-use vs multiple-use endoscopes including in Gastroenterology – prime user of endoscopes. Certain sectors of industry have advocated the switch on grounds of infection risk with multiple-use endoscopes.

Various factors contribute to the perceived infection risk, including variation in decontamination practices. The risk may not be as high as suggested. However, the decontamination process itself requires considerable use of resources and chemicals which add to the carbon footprint of endoscopy practice.

Thus, it is vital to gather the appropriate evidence not just to determine the real infection risk but also the carbon footprint and sustainability of single vs multiple-use endoscopes. From an NHS perspective it is also important to determine the economic impact of choosing a low carbon option.

In this proposal, we seek to apply multi methods analysis to determine the relative impacts of single-use or multiple-use endoscopes on infection risk, NHS costs, experiences of NHS and other staff, and on the environment (including disinfection or disposal). This will be achieved through five specific work packages over 24 months by a team of patient and public representatives, clinical, environmental and health economic experts.

Our primary aim is to provide evidence for NHS decision makers on the use of single-use vs multiple-use endoscopes in gastroenterology, with the following objectives and work packages (WPs);

Work package 1. Review of evidence on technical performance, test accuracy and infection risk of single-use vs multiple-use Gastrointestinal endoscopes, and of literature for other WPs.

Work package 2. Assess costs and consequences arising from use of single-use endoscopes compared to multiple-use ones including for specific patient groups (e.g. immunocompromised) and settings (e.g. intensive care unit) taking into account all factors such as costs of purchase, decontamination, consequences of infections etc.

Work package 3. Assess the wider environmental consequences of a shift to single-use endoscopes including impact on scarce resources for their production and effect of disposal, including landfill and incineration, and the greenhouse gases and waste generated.

Work package 4. Explore the views of patients receiving endoscopy and staff involved in using, cleaning and decontaminating endoscopes.

Work package 5. Provide evidence for patients, health professionals, service commissioners, manufacturers, environmental management and policy makers to make decisions on single-use and multiple-use endoscopes.

Working with key stakeholders across the devolved nations including industry partners, we seek to provide the NHS and healthcare professionals (local and globally) with evidence to decide on which types of endoscopes to use. We would produce summaries for policymakers in the four nations, and for National Institute for Health and Care Excellence (NICE) and the Health Technology Board for Scotland.

In addition to addressing the specific questions in Gastroenterology, we will also examine how the environmental issues would apply to other specialties.