Reducing Single-Use Plastics

Well, hello everyone. Welcome and thank

you for joining us here today. I'm Colin

Cave, a headneck surgeon with Kaiser

Permanente, and it's an honor to

moderate this critical discussion on

reducing plastics in medicine. Plastics

are everywhere in healthcare. Syringes,

IV bags, gowns, gloves, packaging,

designed for single use, convenience,

and infection control. But this

widespread reliance comes with serious

risks both to human health and to our

environment. First, let's talk about

health. Plastics used in medical devices

and packaging often contain chemicals

like phalates, bisphenols, and PFAS,

many of which are known endocrine

disruptors, carcinogens, or linked to

possible future infertility and

developmental harm. These chemicals

don't just stay in the plastic. They

leech into IV fluids, medication

packaging, and even the air we breathe.

Microplastics are now found in human

brains, blood, lungs, and even placentas

to the point where fetuses are born

pre-polluted with plastic. If plastic is

meant to help us heal, why are we

exposing our most vulnerable patients,

infants, pregnant women, and those in

the intensive care units to these

harmful

substances? Then there's the

environmental crisis. Healthcare

generates vast amounts of plastic waste,

most of which is not recyclable.

Instead, it's incinerated, releasing

toxic air pollutant pollutants like

dioxins and furins, or it's sent to

landfills where it can persist for

centuries, breaking down into more

microplastics that contaminate water,

soil, and food. The carbon footprint of

plastic production and disposal is

staggering. Plastic manufacturing alone

accounts for a significant share of

global fossil fuel use and contributing

to climate change, which in turn

exacerbates an ongoing public health

crisis. So, what can we do? Today, we're

going to hear from three leading

physicians tackling this issue from

different angles. Dr. Hillary will share

how clinicians can actively work to

reduce plastic use in healthcare and why

clinicians can lead the drive to

systemic changes. Dr. Barb Ernie will

discuss the power of specialty society

collaboration in reducing waste and how

organizations can push for better

alternatives. And finally, Dr. Priy

Morotra will address one of the biggest

challenges, the balance between

sustainability and infection control and

touch on what's being done to safely

reuse medical equipment. The stakes are

high. Plastic has played a crucial role

in modern medicine, but we have to ask,

are we using it wisely? Are there safer

alternatives? And how can we build a

health care system that prioritizes both

patient safety and planetary health?

With that as our background, let's get

started with the conversation. I'm going

to turn it over first to Dr. An. Dr.

Well, thank you so much Dr. Thank you

for that um introduction and uh special

thanks to the National Academy of

Medicine for uh inviting me to speak um

uh and lead a discussion with my

co-panelists on this very important

issue which is plastics and healthcare

and what to do about it. So as uh Dr.

Caven highlighted healthc care uses and

disposes of a significant amount of

plastics and we are definitely part of

the problem uh relying especially uh

heavily on single-use plastics and we

need to be a part of the solution. Uh

next slide

please. Plastics is polluting at every

stage of its life cycle from production

to disposal. On the production side

about 98% of plastics are made from

fossil fuels. So we're talking about

oil, coal, and gas. And on the waste

disposal side, plastic waste pollutes

the environment through plastic

particles like Dr. Caven mentioned,

microlastics, nanoplastics, and leeches

petrol chemicals such as BPA, PAS,

phalates, DA,

DH. Um just of note, plastics never

decompose. It just degrades into smaller

particles. So it's always uh uh will be

hanging around in um our

environment. Um looking within our

health care system um from US health

care facilities approximately 7 million

pounds of plastic waste is being

disposed of a day and more than 90% of

this plastic waste is not recycled. I

think mostly because it cannot be

recycled in the form of soft plastic. So

we're talking about plastic uh

packaging, IV bag solutions um

etc. Um and of note packaging and

textiles are the largest markets for

single-use plastics in the

world. Um so we are truly in a poly

crisis. So being climate change as it

relates to fossil fuels and uh plastics

production and waste as it relates to

fossil fuels as well. Uh next slide

please. Um we will never get rid of

plastics but like Dr. Cave had mentioned

that we really need to look at our

judicious use of plastics in health care

and especially dramatically reducing our

reliance on um single-use plastics in

healthcare. A couple uh months ago last

year um two friends and colleagues of

mine Dr. Theel and Dr. Singh uh

published a viewpoints article in uh

JAMA titled healthcare actions for

reducing plastic use and pollution. Next

slide,

please. Um, and the article outlines uh

seven strategies for reducing plastics

use, especially single-use plastics in

healthcare. And I want to walk you

through very broadly these seven

strategies. So, um, going from left to

right, top to bottom. So,

organization strategies. Um, so this is

conducting at an organization or

healthcare system level a landscape

analysis of plastic use. um conducting

plastic waste audits and uh working with

the hospital systems procurement um

infection control clinicians etc on

alternatives of single-use plastics and

how we can replace single-use plastics

where possible. Next in clinician

engagement how to involve clinicians in

the triaging of single-use plastics. So

what is needed? What is uh clinically uh

necessary? what is clinically

unnecessary and ideas for

replacement. In terms of research and

data, we need more uh studies on the

health impacts of plastic exposure. And

of course, over the past couple years,

this is a hot topic and more research is

being done, but we need to continue that

line of

research. Um also needing data on um on

collecting um data on safety infection

control to guide re reusable

alternatives in terms of culture change

shifting I think from norms which is you

this single use and toss culture um and

how we can shift away from that in terms

of circular infrastructure promoting

reuse recycling and durable

alternatives.

Lastly is policy reforms and that's

where I think that um much attention and

advocacy needs um to be made um in

policy changes um as we draw from like

old playbooks and and fighting against

the tobacco industry as an example um

and as a clinician really voicing our

concerns on health impacts to policy

makers um in the health our health care

system and our government level. And

lastly, technology materials um um newer

bioplastics and um newer types of

materials are being um u manufactured

and uh developed. But we need to be

judicious and careful about adopting

these new plastics as uh there was a

recent study that was published last

year uh stating that more than 50% of

these quote unquote bioplastics are

fossil

fuel-based. Next slide, please.

Um lastly, I just want to walk you

through um an um waste uh reduction

project that I was involved in. And for

me, it's is uh looking at a lacer

laceration repair kit in the pediatric

emergency department. Um can you play

that clip,

please? Uh this is me opening up a

singleuse laceration repair kit um every

time I need to perform a laceration

repair with sutures. As you can see,

it's it's this kit with layers of

packaging, plastic packaging. And out of

the 36 items in this kit, I only

routinely use two of those items. Next

slide, please.

A wonderful medical student and I got

together and and looked at this issue

and found that my colleagues um also

have similar practices in that they only

routinely use a couple of instruments

and approximately 75% of the kit is

completely untouched unused and because

it's single use it's tossed in the

landfill waste bin. When we asked my

colleagues uh what are the essential

instruments that they need, they said

three things, needle drivers, forceps,

and scissors. And so when we compare our

current practices to our ideal

practices, there's an opportunity to

reduce our emission footprint by 466%

and reduce cost by

367%. So in my book, it's really getting

at that triple bottom line. Good for

people, good for profit, um and good for

the planet. Um the next step is really

working with the hospital to pair down

these kits. And my last slide,

please. Um well, thank you for your

attention and without further ado, um it

is my pleasure to pass the baton to Dr.

Barbara Envy.

I just want to say one word to

you. Just one word.

Yes, sir. Are you listening? Yes, I am.

Plastics.

Exactly. How do you mean? There's a

great future in

plastics. Think about it. Will you think

about it? Yes, I will. Enough said.

That's a deal.

Well, the future of plastic is here now

and the cost is high to people, the

planet, and our medical colleagues and

practices. A few years ago, some of my

opthalmology colleagues discovered that

we produce the most trash of any medical

specialty. A small group of us were

mortified that we were such a huge cause

of the plastic waste problem. However,

we saw this as a triple win opportunity.

Next slide.

Today I'm going to talk about what we

did and also how to engage your

specialty in plastic waste reduction.

Next

slide. A survey of cataract surgeons and

o nurses revealed that 90% were

concerned about climate change and 93%

felt our trash was excessive and also

that we should be seeking ways to reduce

our waste. The majority also felt that

we should find ways to reuse supplies

and instruments. Next

slide. The study also revealed that most

surgeons do not have a high preference

for single-use items and patients

regarded single-use items as a low

priority, but there was a perceived

safety benefit of disposable

instruments. Next slide.

Several of us had spent time in the

Aravant eye care system in India where

sustainability is a top priority to

provide high value care to both paying

patients and recipients of charitable

services. This slide shows the garbage

generated by one cataract operation in

the US compared to 93 of the same

operations in India at

Aravent. American opthalmologists and

environmental engineers were involved in

peer-reviewed studies showing that not

only were the visual outcomes equivalent

to the US and the UK

next. But the infection rate was

actually lower than

ours. Next slide.

On Earth Day 2022, a small group of US

and European cataract surgeons launched

I sustain, which has become a global

coalition of societies, organizations,

and opthalmologists dedicated to make

eye care and surgery more sustainable.

Next, our mission is to engage, network,

and educate our athic community about

more sustainable practices to

collaborate with industry to reduce our

waste, support research and innovative

solutions, provide education about the

public health impact of climate change

and health harms of medical

waste, and participate in advocacy to

affect change in regulations.

We now have over 50 societies globally

as members of I sustain. Next slide.

On our website, we've continu we have a

continually evolving library of

literature and links to several topics

including sustainable practices in the O

and clinic, how to reduce drug waste,

initiatives from low to middle inome

countries, human and planetary health

impacts of medical waste, and industry

efforts. Next slide.

We highlight what industry is doing and

our mutual accomplishments. When

collaborating with industry, we need to

remember that we are the customers. A

few years ago, several opthalmic

instrument companies wanted to make

every cataract surgery pack contain all

disposable plastic

instruments. Opthalmologists immediately

fought back, especially key opinion

leaders, and said they would refuse to

buy anything from those companies.

Quickly that proposal

disappeared. Thankfully we are now

working together on win-win

scenarios. Next

slide. This surgical pledge was

developed to empower doctors, nurses,

and staff to make a difference in their

operating rooms. Our medical student

team has developed a toolkit for each of

these

goals. Next slide.

I believe the key to our initial success

was having a physician champion with

status and

connections. Someone who is well

respected in your specialty and has had

powerful positions can influence current

leadership. Of course, you also need a

team of passionate physicians and other

stakeholders. Our young doctors and

medical students have been essential in

research projects, social media, writing

articles, contributing to the website

and app, and speaking at

meetings. Advocacy and changing laws and

regulations will ultimately determine

much of our success. Next

slide. So, there's no time to waste.

Start an initiative, committee, or

project in your own specialty today.

Thank you.

Now I'd like to pass it on to Dr.

Meotra.

Thanks so much. It's my privilege to be

here today as well to talk to you a

little bit more about environmental

sustainability and the infection control

perspective. Next

slide. So I want to first start by

acknowledging the tension that I think

exists between these two fields

infection prevention and sustainability

work. The cornerstones of our work in

infection prevention include the use of

transmissionbased precautions and

principles of disinfection and

sterilization. And it's true that

infection prevention may often support

the use of disposable items to decrease

transmission risk. And yet we know that

healthc care remains a carbonintensive

sector as we just heard and that

addressing climate impact requires

multilateral and multis- sector change.

Next slide.

So, I'd like to use both medical devices

and personal protective equipment as use

case scenarios for demonstrating that

tension. For medical devices in

particular, I want to step back and

offer this audience an understanding of

how infection preventionists and

regulators often view medical devices.

On the bottom of this slide, you see

non-critical instruments. These are

instruments that come into contact with

intact skin or the environment. And for

appropriate cleaning and disinfection,

they only require the use of a hospital

approved disinfectant or germicidal

wipe. Next, we have semi-critical

instruments. These are those that come

into contact with mucous membranes and

they require something called highle

disinfection, which refers to a chemical

process that kills at least 10 to the 6

amount of microorganisms on those

instruments. The most stringent is the

critical instrument. These are

instruments that come into contact with

sterile body tissues and these require

sterilization. So going above and beyond

that 10 to the sixth uh level that I

mentioned and it also includes

sporocidal

activity. Next

slide. So we believe there's some

seminal events in healthcare that have

really shaped how we interpret and use

that spalding criteria. The first of

course is HIV epidemic which really

brought to bear bloodborne pathogen

transmissions and also the use of

universal precautions. The second which

I believe is less discussed outside of

the infection control community is a

series of outbreaks of

multi-drugresistant organisms likely

linked to incompletely or

inappropriately disinfected

datadoscopes. And the third of course is

the corona virus pandemic which has

really brought to the forefront the

importance of cleaning, sterilization

and

disinfection. Next slide. So it was all

of those experiences within healthcare

that really I think have brought to bear

our current marketplace. This idea that

out of necessity there needed to be

innovation on the part of manufacturers

in creating a market for single use. So

in November

2019, we have the advent of datadoscopes

with singleuse or disposable parts and

now have completely single-use

Dadnoscopes. And then quickly we follow

suit in 2021 with bronoscopes and in

2022 with the reader scopes as questions

were raised around how to reprocess

these devices appropriately or

effectively. Next slide. So how do we um

balance this tension? I think that we

really have to stratify risk together.

So going from thinking about complete

zero harm and zero waste to absolute

opportunities for risk reduction both

for the planet and for our patients to

thinking to ourselves and really

studying in the literature are all

medical devices created equally? Are

there are in fact some devices that are

higher risk than others? for examples

are there higher risk scopes with

channels and crevices that might

actually be higher risk for infection

than many of the other devices my

colleagues outlined and I think there's

also a broader concept we need to

consider which Dr. on touched on which

is the idea of the circular economy

going from inception to waste. Are there

opportunities in production to think

about rethinking, redesigning and

reducing our production? And in use and

consumption, are there opportunities for

reuse, repair, remanufacturing, and of

course for

recycling? Next slide. Shifting away

from medical devices and moving on to

personal protective equipment. Many of

you might be familiar with the body of

work that's reconsidering the use of

contact precautions or gown and gloves

for patients who are colonized with MRSA

and VR. So first asking ourselves is the

use of this personal protective

equipment appropriate and judicious in

the first place and then if we do need

to use something like gowns and gloves

are there more environmentally friendly

opportunities such as considering uh

reusable gowns versus disposable gowns.

In this one study, we found um Bazole

and colleagues found that the use of um

uh reusable gowns was associated with a

93% reduction in solid waste

generation. Next

slide. So how do we embrace these

challenges together? As our colleagues

touch my colleagues touched on really

thinking about multiplinary dialogue. So

environmental sustainability program

managers should share their goals, their

obstacles, and their visions with their

colleagues in infection prevention

control or IPC. And they should really

to work to establish partnerships such

as the ones Dr. Ernie mentioned looking

at institutional waste and recycling

partners. Clinicians need to be involved

with their infection prevention control

programs and clinical engineering when

triing new equipment. Procurement and

supply chain need to ensure that IPC and

sterile processing departments have

reviewed the requirements related to

cleaning and disinfection for equipment

that is brought into the facility and

sterile processing departments play a

role in sharing and discussing any

operational or regulatory updates or

challenges and identifying opportunities

for thirdparty reprocessing or other

recycling opportunities.

I'm in debt, of course. Next slide. To

my colleagues in my infection prevention

team and to my colleagues on

environmental sustainability. Thanks so

much for having me and it's my pleasure

to hand it over back to Dr.

Cave. Thanks very much. Uh in my

conversations with our panelists

beforehand, I can assure you they can

talk about these issues for hours and

they are just such a wealth of

information. I'd like to go ahead and

ask them each a specific question and

we'll open it up to the uh to the

viewing audience. Dr. Let's start with

you. Go back in order here. You've had

firsthand experience in this in a major

institution. How can individual health

care professionals advocate for

sustainable changes in a health care

setting, especially when you're dealing

with cost and regulatory barriers?

Uh well, thank you for that uh question,

Dr. Cave. Um I'll uh give an example um

of approach to this issue and and

speaking really from my experience and

and offer some lessons learned. So um I

felt I started with the lone my lonesome

self like in the pediatric emergency

like department. Um and I started to

find colleagues who want to work on an

improvement project and a patient safety

like issue with me and and as it relates

to um environmental or clinical

sustainability. Um so that's why I

picked the laceration uh repair kit, the

procedural kit that kind of peeves like

all of us um in the emergency

department. Um so first I think like

starting off as an individual like

finding um like-minded colleagues or

nursing staff or other staff that would

work with you on this project and uh

reaching out to sort of broader national

organizations um like healthcare without

harm like this newly formed uh PANAP

group which is a physician scientists um

and advocating for reduction in plastics

um and then um tackling an either a

clinical operation or a waste reduction

project and I think once we have those

players and a project in place um um

then I think making friends across um

your institution so like in procurement

in office sustainability in the seauite

and leadership and I think before uh

this is one lesson learned I think

before kind of approaching leadership

needing to make clear of that uh triple

bottom line idea that I mentioned in my

presentation so uh what is uh good for

profit. So is this a a cost reduction or

at least cost equivalent project? Um is

it good for the planet? Is it safe for

our patients? Um I will offer sort of

two last points that like uh Dr. Morotra

mentioned um uh this work is truly

interdisciplinary um and in reducing our

single-use plastics in healthcare and

it's not just an environmental issue but

it's also about patient safety,

financial and uh an operational concern.

So I think if it's we frame it that way,

it really aligns with multiple

stakeholder um priorities. So um happy

to to chat more and answer other

questions. Great. Actually, I think we

have uh one timely question that came in

as you were talking. What push back did

you get probably from somebody who's

thinking about doing this themselves? I

mean, it's it's great if everybody's on

board, but uh not every facil facility

is the same. So what push back did you

get or what have you heard from your

colleagues that have done the same?

Yeah, great great question. So, um I

think for me um just that one project

that uh I was leading and in particular

the laceration repair. So, um the push

back is one cost. So, I knew I needed to

do a cost calculation um of our current

um use and waste. And I I think a word

about that is that um most of our cost

calculations about upfront cost. of the

cost of purchasing the material and um

forgetting to factor in the cost of

disposal. The hospital spends a lot of

money um u paying for waste management.

So whether or not is landfill or

regulated medical waste etc. Um excuse

me. So uh I think calculating that cost

into that upfront cost um is important.

Um so uh I I think the argument is

stronger if we take it up to leadership

if it's a cost reduction and cost

equivalent. Um and uh the second issue

uh I've been dealing with I think

someone in the uh Q&A had mentioned or

had um asked about uh sterile processing

and autoclaving and that for us in the

Bay Area is very costly as we have felt

that everything is costing more these

days and um that has not uh for me some

of these uh uh engagement project

calculations has not proven to be a cost

savings. Um, so, um, I think needing to

work slowly with leadership, um, to say

if they can put out that upfront cost,

um, and and needing to just chat about,

um, and hopefully persuade them with,

um, the other kind of possible value

base or patient safety base and

population health like um, uh,

consequences of of continuing to use

single plastic.

and the the um uh reducing that impact

of health harms in downstream and also

upstream of that. So really kind of

pivoting to more valuebased an argument

than a cost savings argument if that

doesn't prove to be true.

Wonderful. Thank you. Um Dr. Ernie,

let's turn to you. We we've talked with

Dr. Ang about within a large

institution, but you've moved the fight

outside of your own institution. So, uh,

one question real quick and then I'll

have a follow-up when you're done. How

did you get the word out about I sustain

and its mission? Because obviously it's

a great mission. It does great work, but

you've got to spread it out to get

people and their buy in. H how did you

get the word out?

Well, as I thank you. I as I mentioned

in my talk, we had an announcement at

our um annual cataract meeting on Earth

Day 2022 and the European Cataract

Society who is initially started this

with us did the same. But after that we

have our um we've had time at the

opening sessions of our meetings for our

cataract society and now for the

American Academy of Opthalmology which

is the largest opthalmology society in

the world. So they've all allowed us to

have announcements and a maybe panel

discussion at the opening session where

everybody attends. We have

sustainability courses at each of those

meetings. And we've got social media. So

we've got students and young

opthalmologists who post um on social

media just little updates. They direct

people back to the website. We have um

sometimes on the floor of meetings we

have a little space where we can we can

show I sustain and show what we're doing

and have some posters up from the

medical students even to just um display

different ways we've made progress over

the year in

sustainability. And we even have um

opthalmologists writing position papers

now that are getting published in major

journals on accomplishments we've made

through studies we've done on infection

control or recommendations to reduce

plastic waste that have no negative

impact on the patient. So we are getting

papers published and position statements

supported by our American Academy of

Opthalmology and we've gotten 53 member

societies now worldwide each of which

actually talk to their members about

being involved in sustainability and and

looking at the I sustain uh sites and

and even industry is really been our

partner in this. I just found out that

um Alcon actually has offers long drapes

and short drapes for eye surgery. Now

it's to us we know it's ridiculous to be

covering the feet. I'm sure Dr. Marotra

can realize that there's not really an

infection that flies from the foot to

the eye during surgery. But many

surgeons still choose to use a full body

drape. But we are really pushing for

short drapes. and Alcon has labeled the

short drapes in their packs as I sustain

endorsed. So even with industry, they're

they're trying they don't want to be in

the business of selling long drapes.

They're they're in a much bigger game.

And so um we've just trying to get the

word out through all sorts of channels.

Great. Multiffactorial. I love that. Um

so just a quick followup u besides

building the coalition that you did much

like the question I asked Dr. Ang

regarding what one person can do in the

health care setting um a lot of the uh

attendees are interested in what we can

do with policy and regulations. So what

can one person do in your opinion to

affect change in regulations uh that

that would be important to us?

Well, I have a a great example of of one

of our opthalmologists who was one of

the initial instigators of I sustain,

Dr. David Palmer. He's at Uni Chicago.

He was really frustrated and this is

what starts a lot of it. As Dr. Hong

said, you're you're one physician,

you're frustrated with something you see

in the hospital that just looks

ridiculous.

and he was seeing that the topical eye

drops we use to prep preop patients were

being purchased. Patient had to pay for

it and then they were given one drop and

the entire bottle was discarded. They

couldn't take it home. They couldn't

reuse it on another patient. He was

frustrated. He he himself submitted a

resolution to the Chicago and Illinois

state medical societies advocating for

patients to take home their

medications after postupuse and it was

adopted. A modified resolution was

introduced to the Illinois General

Assembly. It became state law and has

subsequently been utilized by our

academy of opthalmology as a template

for four other state legislators to

date. Um the AMA has ultimately adopted

a similar policy by adding support for

the safe use of multid-dosese eye drops

on multiple

patients. And so with this support of

these major societies that resulted in a

multi- eye society position paper on

this issue and uh we've got studies

going on right now showing there's no

contamination when this is done properly

and and drops are administered by

professionals. So one person getting

frustrated like Dr. Ang has set off a

change in state law, multi-position

papers, AMA on board. So it really I

want everyone to feel like you can do

one person can start this whole domino

effect and chain. So try to try to use

your frustration for action.

That's awesome. Thank you. Um all right,

let's get back to you Dr. Morotra.

Speaking of one person in infectious

disease, um, no waste would be the ideal

situation, but it's not really close to

reality in healthcare at present. Um,

you've talked about the importance of

the circular economy. I think many of

the people on this conference are aware

of it. Some are probably not. What are

the data we need to start making that a

practical reality in healthcare to get

us closer to the mark we're looking for?

Thanks for that uh question. I think you

know we talked um already in the

questions we've heard about what are the

barriers that we face and how do we

create that change. I think data is

actually really important and essential

in in creating change um regardless of

who your audience is but especially

including um the seauite for example. So

I think really thinking about life cycle

analyses or what we call cradle to gay

grave analytics um is really essential.

So in the case of manufactured products

or medical devices that would be

thinking about the environmental impacts

and the financial impacts from the raw

material extraction. What does it take

from the cradle to make this device all

the way through that product's

manufacturing, that product's

distribution, that product's use, and

then importantly as Dr. mentioned that

product's final disposal or recycling or

reuse. All of that should be measured

for medical devices. Um, and we have

some of that data for some devices. We

have some single center studies, but I

really think we need really large scale

LCAs or cradleto crave analytics to

understand what is the true

environmental impact or footprint,

especially when it comes to complex

medical devices. those that might be

more difficult to create, those that um

are complex and have crevices in them,

for example, which is when we know there

can be an increased infection risk, and

those that also have um really more

taxing and labor intensive uh components

when it comes to the reprocessing steps

for those devices. And then we need to

match those LCAs with decision analysis

data and financial data to understand

really the large impact of how much does

it cost to go into manufacturing and

distribution and or recycling. As Dr.

mentioned, institutions often spend

quite a bit of money to have partners in

the waist stream and recycling um piece

of this. And so understanding really

what's part of that partnership um is

incredibly essential.

Wonderful. And so I'm going to start

with you, take a modify a a viewer

question and start with you and then if

Dr. Hong or Dr. Ernie want to add, they

can um having to do with reprocessing

devices. Obviously, as an infectious

disease specialist, we all have examples

of whether it's a speculum or a scope or

whatever. um reusing versus reprocessing

in the operating rooms. It's not that

easy to just collect instruments and

send them back. And our purchasers can

tell you they have a a certain percent

they have to purchase that's new um or

they're not going to get the the um

discounts that they need. So, what are

the obstacles that you see in real time

to reprocessing? And and what do you

think maybe five years from now it's

going to look like if we figure that

out? um how reprocessing can help to

replace some of our just purchasing.

Sure. I mean I I think that um the work

of reprocessing and the work of um

certainly appropriately disinfecting

devices um as it as referencing in the

instructions for use of the IFU for that

device. Um that's taxing hard work. Some

of the IFUs for medical devices can be

hundreds of pages. And so really

thinking about who is in your sterile

processing department. Do they have the

training, the support, the guidance, the

technology, the infrastructure that they

need um to make that the most efficient

space? That's absolutely essential in

trying to I think really take advantage

fully of reprocessing and reusing

devices as we can within our

institutions. they are really the

heartbeat and play such an important

role in trying to get at this um

question of uh reprocessing certainly

complex medical devices.

Dr. Hong, in your facility, yeah, I I'll

jump in. So, I would say um UC has an

action plan across all campuses to phase

out single-use plastics. um but it's

really focusing on like um beverages um

plastic bottles and hasn't moved into uh

PLA a medical plastics yet. Um but I

think with that backdrop um I want to

emphasize that it's so important uh to

have the institution create an action

plan or policy to help guide this

because um um this is truly

multiddisciplinary. I don't know the

operations as a clinician uh fully the

operations of sterile processing but um

I think that we're at this kind of

crisis state of plastic pollution that

we have to do something about it um and

I would lean on um an approach or a

thought that my colleague Dr. Theo had

mentioned which is going back to old

school. So, can we transition from

single-use plastics, all this plastic

packaging and just one time use and toss

in the trash can to back to glass, glass

syringes, glass IV solution bottles. Is

that possible? That is still a question

mark. But that is going to be heavily

relying on our sterile processing

department and uh if the institutions

are committed to doing this, it it has

to invest in this. Um also I would say

that there's no free lunch is that

sterile processing also um ha um has uh

emission um footprint related to it. Uh

but uh we can potentially dramatically

reduce our single plastic reliance.

Thank you Dr. Ernie. I'm going to give

you the last question. We got about a

minute and a half for this one. um

because of your connection with other

businesses as you've been moving in with

I sustain what advice would you give to

industry on how to help those of us in

the healthcare world that are trying to

take this on?

Yeah, thank you. Um we've realized

working with industry that they're just

as frustrated with regulations and

policies and laws that don't make sense

as we are there. You know, I think

doctors, maybe some of us have had this

idea that it's kind of an us against

them in this game, that they just that's

their job. They want to produce as much

waste as they can, but they actually

don't. Um, that we've talked to several

very large industries that work with

opthalmology. Their younger employees

are demanding them to be green. They're

switching over to solar. They're doing

they're doing things to green their

industry aside. And then with with us,

they really don't want to be in the

business, like I said, of making a long

drape. They that's that's not the best

use of their manufacturing or their time

or making packaging. So, they're

really they really are on board on

win-win scenarios. Now, we started with

win-win scenarios. You saw my slide of

Dr. Chang holding that giant IFU for an

intraoccular lens. Now, 20 million of

these are sent around the world. It's

reams of paper and we got industry to

change it to a QR code in any country,

which is most of the world that would

would let them. Now, that's a win-win.

They don't want to be in the paper

business. We don't want that. It's

getting, you know, now it's getting

tougher as we're negotiating. How can we

reuse our plastic tubing? How can we

reuse the plastic? Because then we get

into they're going to sell less. Are

they going to be happy? There's got to

be a happy medium. Charge us more and

let us reuse it. I mean charge us the

same but let us reuse it so we don't

waste the plastic and harm our patients.

So or the community. So it's um you know

just for industry the word is young

doctors especially doctors now care

about this. They are looking like when

we said we absolutely will not use

disposable instrument packs and

everybody said that especially our key

opinion leaders they backed off. So I

think they know we're the customer and

if we start to uniformly like with this

I sustain with 53 I societies around the

world saying we will not purchase from

company X if you don't you know comply

with our requests. I think that's that's

pretty huge great wisdom. All right.

Well I thank you to our panelists for an

insightful and very thoughtprovoking

discussion. I enjoyed myself today.

We've explored the urgent need to reduce

plastic use and waste in healthcare.

We've gone over some concrete steps

clinicians and industry leaders are

taking and the ongoing challenges we

must address, particularly when it comes

to infection control and reusable

medical equipment. The reality is that

healthcare cannot afford to continue on

its current path. As we've heard,

plastic waste is not just an

environmental issue. It's a direct

threat to public health and the

sustainability of our medical systems.

But today's discussion has also shown

that solutions exist. Clinicians are

leading change at the bedside. Industry

leaders are organizing for collective

impact. And innovations in sustainable

purchasing and sterilization are making

a difference. So the question we want to

leave you with today is this. What role

will you play? Whether you are a

healthcare provider, policy maker,

researcher, or concerned citizen, your

voice and actions matter. Advocate for

change in your institution. Push for

purchasing practices that enhance

sustainability and safety. and challenge

the assumption that single-use plastics

are the only way forward. We need your

help. Please help us continue this

conversation beyond today because a

healthier future for both our patients

and our planet depends on what we do

next. I'd like to thank our amazing

panel for their insights and expertise.

To NAM staff for putting on a valuable

and needed webinar series and of course

you all for taking time for your busy

day to listen, learn, and interact with

us as we take on these important issues.

Have a great day.