Elucidating medication waste for outpatient clinic procedures with intralesional triamcinolone

Summary: Abstract Body: With over 10 million procedures conducted annually in the U.S., single-use intralesional injections performed by dermatology pose significant environmental challenges and contribute to the growing issue of medical waste. At our institution, intralesional triamcinolone is drawn up from a single-use vial into a single-use syringe with the remaining unused medication discarded. This research aimed to quantify the extent of medical waste generated by intralesional triamcinolone injection procedures and to identify areas for minimizing this medical waste. We conducted a retrospective chart review for patients receiving intralesional steroid injections with Kenalog-40 or Kenalog-10 at our academic institution from 01/01/2020–12/31/2023 for the treatment of scars, keloids, or different types of alopecia. Analysis of 650 patients demonstrated that a total of 101.7mL of Kenalog-40 and 171.0mL of Kenalog-10 were used. There were 124.4mL of discarded Kenalog-40, equivalent to 125 vials (1 mL/vial) and 140.6mL of discarded Kenalog-10, equivalent to 29 vials (5 mL/vial). We found that about 60% of Kenalog-40 and 52% of Kenalog-10 were wasted, exceeding the amount utilized. The estimated total carbon footprint from the glass vials alone is 8.6g CO2e per Kenalog-40 and 11.12g CO2e for Kenalog-10, totaling about 1.4kg CO2e. This value does not include waste of the medication itself nor supplies such as gauze, gloves, and syringes used in the procedure which would further compound the environmental impact. Our results highlight an urgent opportunity to reduce unnecessary medical waste from single-use medications and the importance of considering how our daily practice affects our environmental impact. Encouraging sustainable practices such as optimizing medication dosing and preparation, implementing a return program for unused medication, and increasing awareness may help minimize medical waste in dermatology. Jordan Bui¹, Christine Chow¹, Margaret Greer¹, Michael Lindberg², Thomas Stringer² 1. Georgetown University School of Medicine, Washington, DC, United States. 2. Dermatology, Georgetown University Medical Center, Washington, DC, United States. Clinical Research: Epidemiology and Observational Research