In healthcare, disinfection of surgical and medical instruments after each use prevents transmission of infectious diseases. Because the healthcare sector is responsible for 6 to 9 percent of carbon dioxide emissions in Western countries and 5 percent world-wide, the choice of disinfection practices has a significant impact on the environment.[i]
CO2 emissions in healthcare can be attributed to processes such as energy use, chemical and water consumption, equipment production, and transport.
In this blog, we evaluate the efficacy and environmental impact of various disinfection methods in healthcare, with an emphasis on ultraviolet (UV) based technology.
Overview of Disinfection Methods
Pathogens are living microorganisms such as bacteria, viruses, bacterial spores, and fungi that can be transmitted from person to person causing infectious disease. The most common disinfection methods used in healthcare include chemical, physical, or natural type disinfectants that denature these pathogens so that they can no longer reproduce.
Medical instruments such as flexible channel-less ENT scopes must be disinfected, or processed, after each use with one or more of the following methods:
Chemical Disinfectants
Chemical disinfectants such as bleach, alcohol, OPA, and glutaraldehyde, can kill most pathogens when used at strong enough concentrations. However, these agents also can degrade the equipment over time and can be dangerous for the health of staff members working with them.
Physical Disinfectants
Heat in the form of steam is a physical method of destroying pathogens, but can’t be used on highly sensitive medical instruments. Another physical type of disinfection uses ultraviolet light in the range of 240-280 nm. Light at these wavelengths destroys microorganisms by attacking their DNA/RNA.
Natural Disinfectants
Milder natural disinfectants, such as household vinegar or hydrogen peroxide, are safer for equipment, for staff members, and for the environment. However, these types of disinfectants are less effective at destroying pathogens in the healthcare setting and also can damage expensive equipment over time.
UV-C Light as a Disinfection Method in Healthcare
According to the CDC, UV light technology can effectively eliminate bacteria, fungi, viruses, and mycobacteria. While this technology doesn’t inactivate all bacterial spores,[ii] the CDC notes that so far this has not so far caused outbreaks of disease.[iii]
Several types of fiber optic scopes are used to examine patients internally. The process for disinfecting these scopes using UV light begins with manually wiping off any organic material with a microfiber cloth and rinsing with water immediately after each procedure.
Next, the scope is inserted into the UV Smart D60. Inside the chamber, the scope is hung up and illuminated on all sides with UV light for a period of 60 seconds. This entire disinfection process has a turnaround time of 12 minutes and uses only 650 watts of power and no consumption of chemicals or water.
With UV-based technology, disinfection can be performed right within the department or clinic, eliminating the need for transport to a central processing station.
Environmental Impact of UV-C Light in Healthcare
In a joint project with UV Smart and the Reinier de Graaf hospital, researchers at the Delft University of Technology compared the ecological footprint of two methods for disinfecting flexible channel-less ENT scopes.
The hospital performs some procedures in their main building and some at an ambulatory clinic. After each use, the scopes used in the clinic are transported by van to the hospital’s central location and disinfected using an automated washer and chemicals.
In this study, the UV Smart D60, which uses Impelux™ UV light technology that can be located close to the patient care location, was compared with the hospital’s current system.
Energy consumption considerations in hospitals and clinics
For the study, the researchers calculated the energy consumption and equivalent pounds of CO2 emissions generated by each method.
They found that the hospital’s ambulatory clinic operations emitted 1129 pounds of CO2 per year transporting the instruments back and forth to the central reprocessing center. Some scopes were also used at the main hospital location and did not require transportation.
In contrast, the use of a UV Smart D60 near the point of use required no vehicle transportation, and therefore emitted no CO2.
Along with the transportation miles, the researchers calculated the total amount of electrical power and pounds of CO2 emissions used for the hospital’s current automated washing and chemical disinfection system at the two locations. They also added the total gallons of chemicals, and total gallons of water consumed per year.
The UV Smart D60 consumes 0 gallons of water and 0 pounds of CO2 for disinfection of flexible channel-less ENT scopes.
The researchers calculated that by purchasing a UV Smart D60, 408.8 gallons of chemicals, 2,080 gallons of water, 3686.8 KWh of energy, and 1,723 miles of transportation could be saved by the hospital annually. And converting these figures to equivalent CO2 emissions, the D60 could save 19,180 pounds of CO2 per year.
Disposal and recyclability of UV-C bulbs and devices
According to the U.S. Environmental Protection Agency, fluorescent UV bulbs contain poisonous mercury. Properly disposing of these bulbs and recycling them minimizes the amount of mercury that can harm humans or the environment. It also allows reuse of virtually all the components that make up the bulb, including the glass, metals, and other materials.[iv]
Comparison of UV Technology with Other Disinfectants
An ideal disinfectant for use in healthcare should be environmentally friendly, such that it will not damage the environment upon disposal. However, chemical disinfectants, such as OPA and glutaraldehyde, can be harmful to the environment, and some locations have set disposal restrictions on these chemicals.
More natural type disinfectants such as vinegar (peracetic acid) and hydrogen peroxide have no environmental restrictions on disposal. However, these disinfectants have much less efficacy in destroying microorganisms than other methods.
In comparison, UV light technology can provide a more environmentally sustainable, yet highly effective method of disinfection in healthcare settings.
Advantages and Challenges of UV Light Technology as a Best Practice in Healthcare
The use of ultraviolet light is a non-toxic, cost-effective, and sustainable approach to disinfecting healthcare-associated pathogens. The Reinier de Graaf/Delft University of Technology study proves that purchasing a UV Smart D60 could potentially save a hospital system a significant amount of CO2 emissions per year. In addition to a much lower electric bill, the gallons of water used, as well as the gallons of chemicals that must be managed and disposed of safely would be eliminated.
Purchasing a D60 unit does involve upfront costs for the equipment and set-up within a clinic or office. Ultraviolet light can injure human eyes, so staff must be trained to use UV technology safely and dispose of the bulbs properly. However, many healthcare systems may find that the operational and environmental benefits will far outweigh these challenges.
A More Sustainable Option
The ImpeluxTM UV light technology used in the UV Smart D60 can achieve a significant log-reduction of bacterial contamination in flexible channel-less ENT scopes. At the same time, this innovative technology has proven to be more sustainable than traditional disinfection methods.
Healthcare institutions looking to upgrade their disinfection processes must look beyond the standard solutions of yesterday and search out the most environmentally beneficial, as well as the most effective options for preventing the spread of disease from contaminated equipment.
To meet ever more strict environmental regulations, Healthcare organizations can’t rest on the status quo, but must continue research and innovation in sustainable disinfection methods for their operations.
[i] The way to sustainable healthcare: Reduction of CO2 emissions and turnaround time through innovative disinfection methods. Whitepaper by UV Smart.
[ii] https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/miscellaneous.html
[iii] https://www.cdc.gov/infectioncontrol/guidelines/disinfection/healthcare-equipment.html
[iv] https://www.epa.gov/mercury/recycling-and-disposal-cfls-and-other-bulbs-contain-mercury
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