3PC-017 Assessing the carbon impact related to the production of anticancer drugs in isolator and automated chemotherapy preparation robot

<h3>Background and Importance</h3> Healthcare activities are significant emitters of greenhouse gases, notably CO2, a major contributor to global warming. Recently, automation systems for chemotherapy compounding have emerged in hospital pharmacies, offering benefits: increased productivity, smoother workflow, and reduced risk of musculoskeletal dysfunctions. <h3>Aim and Objectives</h3> This study aims to evaluate the CO2 equivalents emitted related to the preparation of an anticancer drug using an isolator (manual preparation) and a robot (automated preparation). <h3>Material and Methods</h3> This study focuses on the standardised production of 500 mg rituximab in 250 mL infusion bags. To reflect usual practices, calculations were based on campaigns of seven preparations, then extrapolated to estimate annual production. The analysis includes resources used (energy consumption, staff mobilisation, waste management, etc.,) and products consumed (medications, medical devices, consumables). Data collection relied on product weighting, information from manufacturers and service providers, and literature. These data were converted into CO2 equivalents using the public databases CareBone (Paris Hospital) and Empreinte (French Agency for Ecological Transition). Total uncertainty was calculated by factoring in uncertainties related to emission factors and activity data, weighted by carbon emissions of each category. <h3>Results</h3> The carbon footprint of producing 315 rituximab 500 mg infusion bags annually was 25778 kg CO2 eq in an isolator, or 25669 kg CO2 eq with the robot. The relative difference is 0.43%. The largest contributor is the medication supply chain, accounting for 98.4% and 98.8% of total emissions, respectively. In the isolator, medical devices and consumables contribute 193.5 kg CO2 eq, and staff mobilisation 184.5 kg CO2 eq. With the robot, these values are 139.5 kg and 2.8 kg CO2 eq, respectively. The uncertainty rate is 64%. <h3>Conclusion and Relevance</h3> Both production methods result in nearly identical carbon emissions. The robot requires significantly less staff, reducing its carbon footprint. However, its greater weight and energy consumption lead to slightly higher emissions overall compared to the isolator. One limitation of this study is the use of a monetary factor to convert rituximab into CO2 equivalents. Nevertheless, it appears that the most effective strategy for reducing the carbon footprint, beyond the choice between manual or automated production, lies in conducting production through campaigns, minimising consumable use. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest