In the 2022 Global Risk Report, “climate action failure” was identified as the most severe global risk for the next 10 years. Thus, to address the climate crisis, the goal of achieving zero-carbon emissions must be implemented across all industries, including the healthcare.1 On average, the carbon footprint of the healthcare industry in 2014 accounted for 5.5% of the total national carbon footprint globally and 5.3% of the total national carbon footprint in Korea.2 Gastrointestinal endoscopy (GIE) is one of the most rapidly developing fields in healthcare; however, due to its nature, it is associated with a large carbon footprint.3 GIE requires numerous disposable items, thus making it the third highest generator of medical waste in hospitals. Green endoscopy refers to the coordinated efforts of various stakeholders to reduce the carbon footprints of endoscopic procedures. Recently, a green endoscopy movement has been developed in Europe to achieve a sustainable future,4,5 and it is just beginning to be translated into Korea. It is important to raise awareness of green endoscopy among healthcare professionals performing GIE, as this concept is relatively new.
Until recently, no surveys have been conducted investigating the awareness of green endoscopy in Asian countries. Therefore, an online survey was conducted between May and July 2023 among healthcare professionals working in GIE centers in South Korea to determine their perceptions of green endoscopy. The questionnaire comprised 14 questions and required approximately 5 minutes to complete. The participants were informed of their voluntary and anonymous participation, and the rationale and objectives of the study were explained. The requirement for informed consent was waived for this online survey, as it was collected anonymously without personal information. In total, 787 participants completed the survey. Table 1 presents the demographic and social characteristics of the respondents. The most common age group was individuals in their 40s (41.9%), and this was followed by individuals in their 50s and 30s. Most respondents (96.2%) were medical doctors (80.8%) or endoscopy nurses (15.4%). Furthermore, the majority of respondents worked at primary clinics (38.6%), tertiary hospitals (26.8%), or general hospitals (26.8%).
Our survey revealed that 73.7% of respondents were concerned in regard to environmental issues, including the climate crises and carbon-zero policies. Environmental concern increased with age, from 36.3% those in their 20s up to 85.7% in those over 60 years of age; however, concern did not differ according to sex, occupation, or hospital volume. Interestingly, 72.7% of the participants took steps to help the planet such as waste separation and the avoidance of single-use containers. Eco-friendly activities to protect the global environment further increased with age, from 54.5% in their 20s to 85.9% in those over 60 years of age. However, these activities did not differ according to sex or hospital volume. Non-medical healthcare professionals participate in numerous eco-friendly activities; however, our survey results were limited by the small sample size (n=9, 1.1%).
The concept of green endoscopy still remains unfamiliar to many health professionals working in the GIE suite, with only 16.3% being aware of the concept of green endoscopy. Surprisingly, the awareness level was much lower among the younger group, with only 27% of those less than 50 years of age compared to 42% of those older than 50 years. The awareness levels regarding green endoscopy did not differ according to sex or occupation. From the perspective of hospital volume, healthcare professionals working at larger hospitals (≥100 beds) were more likely to be unfamiliar with green endoscopy than were those working at smaller hospitals (30–99 beds) and primary clinics (<29 beds), with awareness levels of 20% vs. 42%. Therefore, these survey results indicate that greater efforts are required to increase awareness of green endoscopy among healthcare professionals working in larger hospitals and younger healthcare professionals. However, it is encouraging that 68.8% of the healthcare professionals were willing to participate in green endoscopy campaigns. Willingness to participate in the green endoscopy campaign was highest in elderly participants over 60 years of age (at 80%) but lowest in younger participants in their 20s.
Unfortunately, only 15.3% of the respondents agreed that their GIE suite currently possesses a good policy for green endoscopy (Fig. 1, Q5). When comparing those under 20 and those over 60 years old with those between 30 to 59 years of age, the proportions of individuals who believed that current eco-friendly policies were well implemented were 25.2% vs. 13.6%, while the proportions of those who believed that they were not well implemented were 19.6% vs. 37.2%. Promisingly, 76.4% of respondents stated they would switch to a green endoscopy room in the future (Fig. 1, Q6), and this did not differ according to sex, age, occupation, or hospital volume. Figure 2 presents the 3R (recycling, reuse, and reduction) policies for green endoscopy. Among the 3R activities, recycling (50.4%) was the most common activity currently performed to create a sustainable planet, and this did not differ according to sex, occupation, or hospital volume. Recycling was favored by those under 50 years of age, whereas reduction was favored by those over 50 years of age. Approximately half (47.6%) of the respondents considered reducing as the most important policy for green endoscopy, and there were no differences across age, occupation, or hospital volume. There was no difference in the order of preference for reduction and recycling according to sex, but men were more likely to prefer reuse than were women (26.4% vs. 17.7%).
The most important policy in a green endoscopy suit is the implementation of optimal medical waste segregation. Currently, approximately half (47.3%) of the respondents suggested that the first policy they could implement in their endoscopy suite was reclassifying disposable GIE-related items as recyclable items, and there was no difference based on sex, occupation, or hospital volume. However, in practice, only 37% of medical institutions segregate waste from GIE suits into regular trash, regulated medical waste, and recyclable waste, whereas 43% of medical institutions segregate medical waste only as regular trash and regulated medical waste (Fig. 3). Tertiary general hospitals and general hospitals were more likely to classify medical waste from GIE suits as regular trash or regulated medical waste, whereas secondary hospitals and local clinics were more likely to classify medical waste as regular trash, regulated medical waste, or recyclable waste.
The limitation of this survey was its low response rate, and this could have led to selection bias and differences in sample size according to age group, occupation, and hospital volume. To the best of our knowledge, this is the first study to provide awareness regarding green endoscopy in South Korea.
In conclusion, the awareness of green endoscopy is low among healthcare professionals performing GIE. These results suggest that GIE suites in Korea should implement a green endoscopy policy that considers the high level of concern regarding environmental crises.
Conflicts of Interest
The authors have no potential conflicts of interest.
Funding
This study was supported by a grant from the Korean Gastrointestinal Endoscopy Research Foundation (2023 Investigation Grant).
Acknowledgments
The authors would like to express their gratitude to Seo SI, Lee HJ, Jung DH, Choi YS, Kang BR, Yoon NS, and the members of the Green Endoscopy Task Force of the Korean Society of Gastrointestinal Endoscopy.
Author Contributions
Conceptualization: all authors; Data curation: TJJ; Investigation: TJJ; Methodology: TJJ; Software: TJJ; Supervision: JMC; Writing–original draft: all authors; Writing–review & editing: all authors.
Fig. 1.Survey results regarding the awareness of green endoscopy.
Fig. 2.Use of the 3R (recycle, reuse, and reduce) policies for green endoscopy.
Fig. 3.The first strategy to be adopted for green endoscopy (A) and the current state of classification for medical waste segregation (B).
Table 1.Demographic and social characteristics of the survey respondents (n=787)
|
Survey items |
n (%) |
|
Age group (yr) |
|
|
20–29 |
22 (2.8) |
|
30–39 |
173 (22.0) |
|
40–49 |
330 (41.9) |
|
50–59 |
177 (22.5) |
|
≥60 |
85 (10.8) |
|
Sex |
|
|
Male |
493 (62.6) |
|
Female |
294 (37.4) |
|
Occupation |
|
|
Medical doctors |
636 (80.8) |
|
Endoscopy nurse |
121 (15.4) |
|
Nursing assistant |
21 (2.7) |
|
Others |
9 (1.1) |
|
Volume of hospital |
|
|
Tertiary hospital |
211 (26.8) |
|
General hospital (≥100 beds) |
211 (26.8) |
|
Hospital (30–99 beds) |
61 (7.8) |
|
Primary clinic (<29 beds) |
304 (38.6) |
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