Sustainability in endoscopy: switching from sterile water to tap water

Use of sterile water in endoscopy is common practice but is not based on available evidence, as the literature suggests that the use of tap water in endoscopy is safe and appropriate, even for advanced procedures. We sought to examine the financial and environmental cost savings at our institution after switching from sterile to tap water for endoscopy.

We conducted a comparative analysis of a period of use of sterile water irrigation (October 2022) in endoscopy to an equivalent period of use of tap water irrigation (October 2023). Advanced and invasive procedures continued to use sterile water during both study periods. Our analysis focused on the financial and environmental impact of switching to tap water.

The number of procedures remained stable, with 922 procedures during the sterile water phase and 905 procedures during the tap water phase. Introduction of tap water led to a substantial reduction in sterile water usage, from 336 to 192 bottles per month, saving $310.70 per month. The cost of irrigation water per procedure decreased from $0.80 to $0.47, representing a 41.2% cost reduction. Transitioning to tap water eliminated the need for 144 bottles per month, resulting in a monthly waste reduction of 17.45 kg. The estimated carbon footprint was 54.18 kg of carbon dioxide equivalents from production alone, excluding sterilization, transportation, and waste management.

Use of tap water in endoscopy has been proven to be safe and effective. An additional benefit is the financial and environmental cost savings of decreasing sterile water use. Implementation of tap water protocols in endoscopy units can be a simple step toward increasing sustainability in endoscopy.