Reducing Waste, Embracing Sustainability: Quality and Safety in Women’s Health Applied
By Jane Black
Duke Ob/Gyn is taking a significant step toward environmental sustainability by setting a goal to help reduce its carbon footprint. One way the department aims to achieve this is by lowering the number of plastic speculums used monthly in outpatient clinics from 630 to 315 by Jan. 1, 2026. This initiative is part of the department’s broader commitment to raising awareness about the importance of being a thought leader in creating environmentally sustainable health systems.
In 2024, Duke Ob/Gyn used over 7,000 plastic speculums, which translates to 6,402 kg of carbon dioxide equivalents per year. By eliminating the use of plastic speculums and transitioning to metal speculums, the department aims to save the equivalent of 355 trees annually. This effort is crucial, as the U.S. health care system significantly contributes to per capita health care-related greenhouse emissions. Specifically, 7% of greenhouse emissions are attributed to medical devices and supplies in the health care setting. By making green choices, starting with phasing out plastic speculums, ob/gyns can play a pivotal role in reducing the use of disposable medical supplies.
“Plastic speculums are not only made of plastic, but are also wrapped in plastic packaging, often contain LED lights and batteries and are discarded after a single use,” said Joseph Lafferty, MD, Quality and Safety in Women’s Health fellow. “This practice contributes significantly to environmental pollution. Studies cited in the American Journal of Obstetrics and Gynecology have shown that stainless steel speculums have a lesser carbon footprint over multiple model scenarios compared to disposable plastic speculums, with no significant difference in clinical utility. Additionally, patient comfort feedback studies have indicated that there is no substantial preference for plastic speculums over reusable ones.”
Environmental sustainability has been designated as a departmental priority by Duke Ob/Gyn leadership. A multidisciplinary team, including physicians, nurses, medical assistants, infection prevention and sterile processing staff, has been assembled to tackle this issue. The team has developed a well-defined problem statement: “Duke University Health System Obstetrics and Gynecology clinics use large amounts of disposable plastic speculums despite the availability of more eco-friendly alternatives.”
The project emphasizes the importance of compliance with infection prevention standards and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) regulations as drivers for change.
The current state of the process involves significant use of disposable plastic speculums, while the future state aims to transition to reusable metal speculums. This transition will involve regular meetings with team members and stakeholders, process implementation and larger-scale roll-out at additional sites once initial troubleshooting is complete.
— Joseph Lafferty, MD
References:
American Journal of Obstetrics and Gynecology (August 2020): A comparative carbon footprint analysis of disposable and reusable vaginal specula
British Journal of Obstetrics and Gynaecology (December 2023): Patient preferences for disposable and reusable vaginal specula and their willingness to compromise in the era of climate change: A cross-sectional study