Reducing Clinical Waste in Flexible Cystoscopy: A Prospective Quality Improvement Study

Abstract

Aims
Flexible cystoscopy is a very common procedure that relies heavily on single-use consumables, resulting in significant procedural waste. This study aimed to evaluate whether a targeted waste-segregation intervention could reduce clinical waste generation during flexible cystoscopy without compromising clinical practice.

Methods
A prospective audit of 50 consecutive diagnostic flexible cystoscopies performed at a tertiary urology centre was undertaken. Twenty-five procedures were evaluated before intervention, followed by structured contamination-based waste segregation training for clinical staff and a re-audit of 25 post-intervention procedures. Total procedural waste was weighed in grams, and individual disposable items were classified as clinical or domestic waste to determine segregation accuracy. The annual environmental and financial impact was modelled using institutional procedural volume, disposal costs, and a standard CO₂ conversion factor.

Results
Mean waste weight decreased from 994.4 g pre-intervention to 472.4 g post-intervention, representing a 52.5% reduction. Segregation accuracy improved from 0% to 53%, with 17 of 32 routinely used, non-contaminated items correctly diverted into domestic waste post-intervention. For a service performing 2,000 cystoscopies annually, this equates to approximately 1,044 kg less clinical waste, 1,138 kg lower CO₂ emissions and an estimated disposal cost saving of €1,930.

Discussion
Behaviour-focused segregation training halved total waste generated during flexible cystoscopy and deliver measurable environmental and financial benefits without altering consumables, workflow or infection control practice. This represents a scalable, low-cost sustainability strategy for outpatient urology.