We read with great interest and applaud this article highlighting the waste associated with disposal of the remaining contents of 100 mL povidone–iodine (PVI) solution because of single-use protocols.1 Discussion around improving healthcare sustainability is imperative in our current climate, with a recent survey showing over 93% of 1300 cataract surgeons and nurses believing that operating room waste is excessive and should be reduced.2

The article by Lam et al. described both the economic and environmental effects of PVI wastage in surgical settings at the Flinders Medical Centre. The study found that 72% of unused PVI was discarded equating to $21 857.60 in costs. The authors call for the development of systematic strategies for recycling/repurposing wastage. A study by Bhatter et al. of 34 consecutive cases at an oculofacial surgery have also highlighted high levels of healthcare wastage including 96% of local anesthetics, 71% of intraoperative medications, and 27% for antiseptics, totaling 103 kg of carbon equivalent gases.3

Westmead Hospital, New South Wales, Australia, is a large center providing subspecialty tertiary and quaternary services for patients, including ophthalmology. Since 2008, our center has used 5% single-use compounded PVI bottles. The current process involves sterilizing Riodine Aseptic 10% solution (nonsterile) using a peristaltic pump and disc filter. The sterile liquid is then diluted with sterile basic salt solution to give 5% PVI, which is aliquoted to 15 mL sterile bottles. Sterility testing is performed using samples sent to microbiology for incubation and subsequent result reading while other samples are retained for future testing. The production is conducted by pharmacy technicians and pharmacists exclusively in sterile suite cleanrooms.

The cost of materials for a batch of 60 bottles is listed in the table above (Figure 1). The entire process takes 3.5 hours, with a laboratory technician labor cost of $120 Australian dollars. This equates to approximately $5.17 per bottle per patient comparing favorably with the costs reported at Flinders ($15.50 per bottle per patient). Owing to the smaller volume of PVI and plastic per unit, there is less pharmaceutical wastage generated by our method. In the past 12 months (January 1, 2023, to December 31, 2023), pharmacy distributed 3346 bottles (∼275 per month) around the hospital, predominantly to the operating theaters and the ophthalmology clinic.

Figure 1.:

Compounded single-use PVI 5% 15 mL bottles at Westmead Hospital with associated costs. PVI = povidone–iodine

We commend the authors in repurposing the remnants of their 100 mL bottles. Our experience is shared here with the aim of offering an alternative, more efficient approach with lower cost by using compounded single-use containers with a lower volume. The healthcare system generates large volumes of waste with an obligation to make every attempt it can to safely reduce its effect on the climate. Recognizing and quantifying wastage and highlighting innovative ways of reducing it is the first step. By sharing our experience of not only reduced waste along with cost over the past 16 years, we hopefully contribute to a collaborative dialog that drives further innovation aimed at reducing medical waste.

1. Lam L, Dedina L, Bacchi S, Lake SR, Chan W. Focus on reuse: reducing waste associated with topical preoperative antiseptics. J Cataract Refract Surg 2023;49:1128–1132 2. Chang DF, Thiel CL; Ophthalmic Instrument Cleaning and Sterilization Task Force. Survey of cataract surgeons' and nurses' attitudes toward operating room waste. J Cataract Refract Surg 2020;46:933–940 3. Bhatter P, Cypen SG, Carter SL, Tao JP. Pharmaceutical and supply waste in oculofacial plastic surgery at a hospital-based outpatient surgery center. Ophthalmic Plast Reconstr Surg 2021;37:435–438