A multicentre audit of costs, plastic waste and CO 2 -equivalent emissions of single-use items in flexible nasal endoscopy in UK ENT practice

BACKGROUND: In 2024, ENT UK published national guidance on sustainable practice during flexible nasal endoscopy (FNE), recommending minimisation of nonessential disposable items based on evidence-based literature. Despite these recommendations, anecdotal evidence suggests continued widespread use. METHODS: eq.). Results were benchmarked against ENT UK's 2024 sustainability guidance. A supplementary qualitative questionnaire was analysed using reflexive thematic analysis to explore clinician reasoning. RESULTS: eq. across all six hospitals. Significant variability and frequent noncompliance with national guidance were observed. Key drivers included entrenched departmental habits, cautious interpretations of infection control policies and limited dissemination of sustainability guidance. CONCLUSIONS: eq. emissions. These findings underscore the need for targeted, system-level interventions - including education, policy integration and behaviour-change strategies - to align ENT practice with sustainable healthcare objectives.