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. 2021 Feb 10;5(3):193-198.
doi: 10.1177/2474126420984657. eCollection 2021 May-Jun.

Medical Waste Due to Intravitreal Injection Procedures in a Retina Clinic

Thomas W Cameron 3rd  1 , Loi V Vo  1 , Lily K Emerson  1 , M Vaughn Emerson  1 , Geoffrey G Emerson  1
Affiliations

Medical Waste Due to Intravitreal Injection Procedures in a Retina Clinic

Thomas W Cameron 3rd et al. J Vitreoretin Dis. .

Abstract

Purpose: Medical waste contributes to health care costs and has a direct negative impact on the environment. The goals of this study are to quantify and categorize the medical waste generated by intravitreal injection procedures and identify opportunities to reduce waste.

Methods: This is a prospective observational series. Medical waste from intravitreal injections was collected from 337 consecutive intravitreal injections by a retina specialist over 2 weeks. The waste was sorted, photographed, weighed, and recorded.

Results: A total of 65.6 kg of waste was collected across 3 broad categories: (1) shipping waste (cardboard boxes, foam coolers, cold packs, and bubble wrap); (2) waste from administering the intravitreal injection (nitrile gloves, tissues, wipes, and plastic or paper packaging); and (3) biohazard waste (used syringes and needles). Shipping waste contributed 83% of the overall waste, by mass, and varied greatly based on the size of the order and how efficiently shipments were packed. Cold packs, foam coolers, cardboard/paper, and nitrile gloves were the greatest contributors to carbon emissions and landfill.

Conclusions: Waste due to shipping of medication is a major opportunity for reducing the environmental impact of intravitreal injections. Buying in bulk is a simple way for retina practices to reduce waste. Manufacturers should consider less bulky packaging for branded intravitreal injections; distributors and outsourcing facilities should consider take-back programs to reuse coolers and cold packs. Improved sustainability in the treatment of retinal disease is achievable but requires awareness and optimization of a clinic's routine.

Keywords: intravitreal injection; medical waste; recycling; retina clinic.

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Conflict of interest statement

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Geoffrey G. Emerson, MD, PhD, reports stock in Regeneron and Novartis. The other authors have nothing to declare.

Figures

Figure 1.
Figure 1.
Medical waste due to intravitreal injection collected from a retina clinic over a 2-week period. (A) Sharps and syringes. (B) Waste associated with administration of the injections and shipping.
Figure 2.
Figure 2.
Waste associated with shipping of medication. (A) Cardboard box. (B) Disposable foam cooler. (C) Cold packs. (D) Bubble wrap and air pillow.
Figure 3.
Figure 3.
Waste associated with administration of the injection. (A) Autoclave packaging. (B) Nitrile gloves. (C) Tissues and paper towels. (D) Cardboard package and package insert. (E) Plastic tray and Tyvek (DuPont) lid. (F) Prefilled syringe, needle, cap, and rubber stopper.
Figure 4.
Figure 4.
Proportion of total waste (by mass) due to shipping, administration of the injection, and biohazard.
Figure 5.
Figure 5.
Shipping weight per dose, depending on the size of the shipment. The per-dose shipping weight decreased for larger shipments with more items, for the (A) branded drugs and for (B) bevacizumab.
See this image and copyright information in PMC

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