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• W2070757002 abstract "Shelton et al. 1 identified 41% of anaesthetic waste to be recyclable, including single-use stainless steel laryngoscope blades and intubating forceps. The legal position regarding re-use of single use items is clear 2: a single-use item is permitted for one patient during a single procedure. Reprocessing is prohibited; however, the regulations fail to provide any guidance on scrapping. Furthermore, although the 2011 regulations 3 describe the fate of waste laryngoscope blades in terms of incineration or ‘non-burn’ alternative treatment, recycling is not discussed. If steel was sterilised (to minimise the risk to handlers and processors) before scrapping, it could be recycled within the current UK regulations and generate an income of £1000 per tonne. Moreover, since it is no longer discarded into either clinical waste at a cost of £450 per tonne or sharps bins (£750 per tonne) the used metal is worth closer to £1500 per tonne. At University Hospital Southampton (UHS) we initiated a process for collecting and decontaminating anaesthetic room steel, similar to that in place for other surgical items at the end of their natural life The utility costs of washing and decontamination (Steris Cabinet Washer, Mentor, Ohio, USA) followed by sterilisation (BMM Weston P328, Faversham, Kent, UK) are shown in Table 5. The non-urgent nature of decontamination means that it can be undertaken at slack operating times without delaying the processing of urgent instruments. No additional staff need be employed to facilitate this process. The size-4 Macintosh laryngoscope blade weighs 106 g and a pair of adult Magill's intubating forceps 72 g, with scrap values of 10.6 and 7.2 pence, respectively. The maximum number of laryngoscope blades per tray is limited by space and weight to approximately 60. Both washer and steriliser cycles can process up to five fully laden trays containing 300 laryngoscope blades (31.8 kg of steel). Assuming each cycle runs to maximum efficiency, the cost is 1.34 pence per blade. Extrapolating these results to the envisaged use at UHS of 20 000 laryngoscope blades per year, the scrap value is £2120, the saving of not disposing of the waste an additional £1060, less the processing cost of £268. Our Trust stands to save £2912 per annum. Whilst Shelton et al. claim that recycling anaesthetic waste is beneficial in terms of both financial savings and reducing carbon emissions, we believe they have underestimated the environmental impact. The energy expenditure to produce 1 kg of steel from iron ore is over 10 MJ greater than when produced from recycled scrap steel (21.9 MJ vs 11.7MJ) and the carbon footprint associated with producing 1 kg of steel from iron ore is 1.97 kg vs 0.7 kg of CO2 if that steel comes from scrap 4. Almost all single-use laryngoscope blades are manufactured in Pakistan and then transported thousands of miles, to be used once only and for less than a minute. This is reflected in the carbon intensity of disposable items and is currently 600 g CO2 per £GB spent 5, or approximately 3.0 kg per laryngoscope blade. We agree with Shelton et al. and conclude that the process of recycling anaesthetic room steel reduces environmental harm and benefits hospitals economically. Furthermore, we support the authors’ call for clearer guidance on recycling anaesthetic room steel. If we cannot reduce the need for laryngoscopy and re-usable laryngoscope blades have all but been removed, then recycling the steel is perhaps the only sustainable option and steel saves both carbon and money." @default.
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• W2070757002 date "2012-12-11" @default.
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• W2070757002 title "Recycling steel from single-use laryngoscope blades and Magill forceps" @default.
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• W2070757002 doi "https://doi.org/10.1111/anae.12112" @default.
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