Scope sustainability: slashing single-use plastic bottles

Background The health-care sector is a substantial contributor to greenhouse gas emissions, with single-use plastic sterile water bottles generating considerable waste.To address this issue, our endoscopy programme implemented a multistep quality improvement initiative replacing sterile water in disposable plastic bottles with tap water in reusable containers for upper and lower endoscopic procedures, excluding endoscopic retrograde cholangiopancreatography.Methods We first performed a scoping review that identified no clinical difference between sterile water and tap water in upper and lower endoscopic procedures, highlighting both economic and environmental benefits.A multidisciplinary team, including representatives from infection prevention, infectious diseases, hospital facilities, patient safety, ethics, and endoscopy quality improvement, collaborated to ensure safety and feasibility of using tap water.Institutional approval was obtained, and implementation is being evaluated using an interrupted time series analysis, tracking complications at 1 week and 30 days post procedure.Ongoing surveys collect feedback to refine the process. FindingsEach 1 L sterile water bottle generates approximately 0575 kg CO 2 and contains 240 000 microplastics and nanoplastics.Within the first 2 weeks of using tap water, usage of 480 bottles was discontinued, reducing CO 2 emissions by 276 kg and preventing the release of 115 million microplastics and nanoplastics.Annual cost savings from all three hospital sites are projected at CAD 47 145, based on eliminating 15 715 bottles used for colonoscopies.No increase in complications has been observed.Interpretation This initiative effectively reduced plastic waste and emissions while maintaining patient safety.It provides a replicable model for sustainable health-care practices, promoting environmental stewardship and mitigating potential health risks from microplastic exposure.