Listen to a discussion of this article through our AI-generated podcast.
Beginning with our September 2024 issue, CAP TODAY now offers the option to listen to a discussion of our articles with voices reminiscent of a Siri or Garmin speaker. Since this AI-generated podcast uses technology that is still in its early stages of development, there may be some errors in pronunciation and the tone may sound too upbeat for the material covered.
Valerie Neff Newitt
September 2024—The barriers to using sustainable practices in a clinical laboratory are legion: too much work and too little time, space, infrastructure, awareness, and education. And the waste streams for biohazardous and chemical hazardous material are complex.
It’s therefore challenging to advise how to get a sustainability program going, which is why Joe Wiencek, PhD, D(ABCC), says, “Starting somewhere, anywhere, is half the battle.”
When the European Federation of Clinical Chemistry and Laboratory Medicine issued its guidelines in 2022 for green and sustainable medical labs, its focus was on chemicals, energy, waste, and water (https://www.eflm.eu/upload/docs/EFLM-GREEN-LAB-BOOKLET.pdf). Waste has been the focus of research in the clinical labs at Vanderbilt University Medical Center, where Dr. Wiencek is service line medical director of the core laboratory, medical director of clinical chemistry, and associate professor of pathology, microbiology, and immunology.
He and his Vanderbilt colleagues quantified the recyclable and nonrecyclable biomedical waste when the comprehensive metabolic panel was run on their six Abbott Alinity c instruments from July 2021 to July 2022 (Glover RT, et al. Am J Clin Pathol. 2023;160:119–123).
“We identified specific things we could potentially recycle,” he says, “such as cardboard packaging, plastic reagent wedges, and paper package inserts.” A total of 1089.2 kg of these types of waste materials was estimated to be produced by performing CMPs throughout the year. “Of that, the nonrecyclable portion was 855 kg. There was a smaller recyclable portion—233 kg. So about 21.4 percent of the waste weight was recyclable.”
“We can infer from that information that this is a bigger issue as it relates to all our chemistry area. It really makes you think,” Dr. Wiencek says. “If this is the finding from just one test panel, what might the entirety of eligible recycling waste be for all chemistry tests and other areas of lab medicine?”
In another study, he and colleagues evaluated the analytical performance of Bio-Rad’s Unassayed Multiqual QC, Immunoassay (IA) Plus, and Therapeutic Drug Monitoring (TDM) QC materials to that of assayed Multiqual InteliQ QC (Laryea ET, et al. Clin Chem Lab Med. 2024;62[1]:e9–e12).
“Quality control traditionally comes in a glass vial that needs to be removed from the refrigerator, warmed at room temperature, and aliquoted into plastic sample cups. Those cups were key to our looking at a sustainability effort. Now, two major vendors are making newer QC materials that can be analyzed directly out of the primary tube,” Dr. Wiencek says. “We’ve shown this can reduce the use of plastic sample cups, and we can gather it will save our technologists time.”
The question for them, after the new QC material became available, was whether there was “a way to be more efficient with this material. And we found out that, yes, there is a way to do better.” He and coauthors concluded: “Overall, this study demonstrated that Multiqual, IA Plus, TDM, and InteliQ QC materials provide similar analytical performance. Implementing new tube-based QC materials can reduce [plastic] sample cup waste generated and may improve workflows with direct scanning and loading.”
This study, he adds, is a “great starter for anyone interested in looking at a waste stream.”
Of laboratories’ environmental impact overall, he says: “They consume a lot of energy, use a lot of water, and contribute a lot of biomedical waste. What’s interesting, when you dive into this area, is that it is wide open for researchers. Waste stream evaluations and other studies in this space are limited in the literature, especially in lab medicine,” which means, he says, “There’s no true comprehensive evaluation yet.”
If someone wanted to take a first step into waste reduction, Dr. Wiencek would say paper is a good place to start, especially in clinical chemistry.
“There are method verification studies for new tests as well as quality assurance, quality control, and quality improvement paperwork that gets filled out through the year, which if you were to put into a binder would fill large bookcases every year. So electronic signature efforts would drastically reduce papers that would need to be printed and signed.”
Energy conservation would be his No. 2 suggestion. The Vanderbilt Medical Laboratories at MetroCenter, a new 110,000-square-foot facility, went live March 1. Motion trackers are used to determine if a person is in a room or hallway. “Heating and cooling ramps up when I’m here and ramps down when I’m not,” he says. And the laboratory is located next to a greenway, which makes it possible for people who live in Nashville to bicycle to work.
The “excitement” around the green lab initiative is itself an advantage, Dr. Wiencek says. Once faculty, trainees, and other lab team members learned of the new initiative, during orientation to the new lab, “they started wanting to contribute.”
The next step for them, as he sees it, is to formalize a lab sustainability group to evaluate the various total testing processes in each area of pathology and laboratory medicine. “That could include practices such as test ordering, because if there’s overtesting there will be waste generated.” Specimen transport is another area. “We have couriers all around the city transporting specimens. What types of cars are they using? Are they using energy inefficient vehicles, or could we be using alternative transport systems like drones?”
He acknowledges that it will be difficult to identify ways to recycle the “not everyday recyclable things” that come from laboratory equipment, such as aluminum or other metals. “The paper or card stock is a key target area,” he says.
Of great importance, he adds, is the need to evaluate the laboratory’s vendors’ commitments to sustainable products. The vendor chosen for the new chemistry laboratory is active in this area, Dr. Wiencek says. “I just hope in the future all vendors incorporate sustainability into key discussions around equipment or consumable acquisitions.” He says he has found other vendors to be open to the sustainability conversation.
The 2022 European Federation of Clinical Chemistry and Laboratory Medicine guidelines to reduce plastic waste in labs suggest choosing equipment from in vitro diagnostic companies that produce equipment with reduced plastic content, supply products with reduced packaging and/or environmentally friendly packaging, are willing to take back shells of used equipment for future use, and allow for reusable plastic accessories.
Dr. Wiencek describes the sustainability focus at Vanderbilt Medical Laboratories as “a 100 percent grassroots effort,” adding, “We contacted a few interested individuals who were like-minded and tackled it in that manner.” But he’s quick to acknowledge the barriers. “We have fewer medical laboratory scientists going into the field. People are retiring. There’s only so many hours of the day and yet a lot of these efforts tend to be volunteer driven. Fortunately, there are people who believe in this and sign up to do it.”
One piece of advice: Understand the differences between the recycling program of a university and that of a medical center. The recycling infrastructures of the two entities may differ, but the university, unlike the medical center, doesn’t have to deal with the same volumes of biohazardous and chemical hazardous materials. “They’re two separate entities,” he says of the university and medical center, “and it’s important to know.”
The European Federation, in its guidelines, offers many suggestions, among them the following:
- Install timers on equipment—for example, water baths and heating blocks. Timers ensure the equipment is ready for use when it’s needed and doesn’t remain on long after it’s been used.
- Shut the sash on fume hoods when not in use as the fan on these continuously pulls in heated or conditioned air from the room.
- Biological safety cabinets can be switched off when not required or at the end of the day as appropriate. “These are energy intensive pieces of equipment using approximately half the energy of a house per day,” the guidelines say. Ensure small appliances used inside fume hoods or BSC are also powered off when not in use.
- Keep refrigerators and freezers organized to reduce opening times and save energy and time.
- Managers should insist that suppliers take back packaging materials for reuse or recycling after supply of instruments and equipment.
Valerie Neff Newitt is a writer in Audubon, Pa.