A Brachytherapy Procedural Waste-Audit: Identifying Opportunities to Enhance the Environmental Sustainability of a Department's Brachytherapy Procedural Practices

Abstract

<h3>Purpose/Objective(s)</h3> The healthcare industry is the second leading contributor of waste in the United States (US), behind the food industry, and produces greater than 4 billion pounds of waste annually. Brachytherapy is a resource-intensive yet integral part of radiation oncology practices and patient treatment paradigms. The environmental impact, waste generation, and opportunities for improving the sustainability of brachytherapy procedural practices has yet to be investigated. This quality focused waste-audit aims to quantify waste production of high-dose-rate (HDR) brachytherapy procedures at a single institution. In this, we have identified multiple opportunities to mitigate the environmental footprint of current brachytherapy practices and transition to sustainable healthcare delivery. <h3>Materials/Methods</h3> We performed a cross-sectional, observational study of HDR prostate procedures within the brachytherapy suite of an academic radiation oncology practice. Procedural waste generated in the brachytherapy suite was categorized into biohazardous and non-biohazardous waste. All waste was weighed, photographed, and cataloged after each procedure by auditors using a standardized template. Current state analysis was conducted using independent observational sessions during the brachytherapy procedure. Qualitative analyses were conducted using A3 modeling and involved participation of attending physicians, resident physicians, independent research observers, and radiation therapists. A root cause analysis was performed to identified key drivers of waste production and potential interventions. <h3>Results</h3> A total of 20 randomly selected prostate HDR brachytherapy procedures were observed between December 2021 - February 2022. The average reported biohazard waste per procedure was 0.92kg (standard deviation (SD): 0.45kg), and the average reported non-biohazardous waste was 3.0kg (SD 0.75kg). The average length of time required to complete the waste audit was 6 minutes. Qualitative reports highlighted potential future implementation efforts to include: waste sorting education, analysis of aseptic technique, conversion to reusable products, supply chain analysis, and anesthesia administration technique. <h3>Conclusion</h3> As brachytherapists, we are poised to play a unique and critical role within the field of radiation oncology as leaders in transitioning to environmentally sustainable care. The present baseline study demonstrates that a brachytherapy waste audit is an efficient and feasible approach for identification of waste "hot spots" and future mitigation efforts. Further detailed waste-audits and practice analyses are needed. Our data serves as a model which other institutions might use to evaluate brachytherapy procedural practices.