A multicentre audit of costs, plastic waste and CO(2)-equivalent emissions of single-use items in flexible nasal endoscopy in UK ENT practice

Abstract

Background: In 2024, ENT UK published national guidance on sustainable practice during flexible nasal endoscopy (FNE), recommending minimisation of nonessential disposable items based on evidence-based literature. Despite these recommendations, anecdotal evidence suggests continued widespread use.

Methods: A cross-sectional audit across six NHS hospitals surveyed ENT clinicians on their use of gloves, aprons, surgical masks, lubricants and anti-fog agents during FNE, as well as reasons for usage. Data were extrapolated to estimate annual cost, plastic waste and greenhouse gas emissions expressed as CO2-equivalent (CO2 eq.). Results were benchmarked against ENT UK's 2024 sustainability guidance. A supplementary qualitative questionnaire was analysed using reflexive thematic analysis to explore clinician reasoning.

Results: Extrapolated annual expenditure on single-use items ranged from �7,942 to �12,634 across the region. At a single institution (Wexham Park Hospital), estimated annual waste was 135kg of plastic and 404kg CO2 eq., scaling to 7,389kg of plastic and 22,301kg CO2 eq. across all six hospitals. Significant variability and frequent noncompliance with national guidance were observed. Key drivers included entrenched departmental habits, cautious interpretations of infection control policies and limited dissemination of sustainability guidance.

Conclusions: Single-use items in FNE practice across multiple hospitals diverge markedly from national recommendations, resulting in measurable financial costs, plastic waste and CO2 eq. emissions. These findings underscore the need for targeted, system-level interventions - including education, policy integration and behaviour-change strategies - to align ENT practice with sustainable healthcare objectives.