The healthcare industry increasingly recognises the importance of sustainability. Many of those working within it understand they have a crucial role to play in reducing the industry’s environmental impact.
Given the global focus on mitigating climate change, it is imperative that all agencies seriously consider how best to reduce their carbon footprint.
While central to hospital activities, operating rooms have been identified as a significant contributor to the industry’s carbon pollution problem.
Infamous for their high resource demands, operating rooms consume a substantial quantity of electricity and water. The use of single-use medical equipment and disposables significantly contributes to resource consumption. Various chemicals, like anaesthetics and disinfectants, generate considerable biological waste during routine activities.
This is why healthcare facilities are increasingly considering greener procurement practices, such as prioritising the purchase of products and supplies that are environmentally responsible and choosing suppliers that engage in sustainable and eco-friendly practices.
Implementing policies such as optimising energy and resource usage, reducing waste and using environmentally friendly materials and equipment can also help make a difference. This can involve using energy-efficient lighting and HVAC systems and adopting recycling and waste reduction programmes.
The degree to which healthcare institutions can attain a more sustainable environment varies worldwide. Resource availability, cultural attitudes, economic disparities, access and government policies all influence the speed of take-up of greener practices. For some, sustainable health remains out of reach, but there are pockets of change emerging around the globe.
Here, we summarise a few efforts helping transform the healthcare industry to ensure a continuum of patient wellbeing and a healthier planet.
UK
In a recent article published in the BMJ, Jennifer Taylor considered various efforts to reduce the carbon footprint of surgery in the UK.
The call for change, she said, has become urgent as procedures can generate anywhere from 6 to a staggering 814 kilograms of carbon dioxide equivalents per operation.
Single-use surgical items have increased, especially during the COVID-19 pandemic. Still, she points to evidence suggesting that reusing items like drapes, gowns, and metal equipment can substantially reduce the carbon footprint.
Acknowledging that a revolution was underway to make surgery more environmentally friendly, she also cautioned that ‘inertia and a lack of incentives are stalling further steps towards sustainability’.
She writes that one of the main challenges in promoting sustainability is the need for more transparent information, as manufacturers often keep the carbon footprint of medical products a secret.
However, initiatives like the Greener NHS programme are attempting to bridge this information gap and advocate for transparency.
At the grassroots level, she observed: ‘Surgeons are taking things into their own hands with self-organised initiatives at the community level offering practical solutions that could inspire others.’
This was epitomised by the work of two consultant orthopaedic surgeons in Wales recently when they scooped a sustainability award for their efforts.
Edwin Jesudason and Preetham Kodumuri focused on hand surgery, reducing consumables and clinical waste. Their innovations led to more sustainable surgical practices and inspired further actions to promote sustainable surgery, including performing minor hand surgery in outpatient settings to reduce their carbon footprint and generate cost savings while maintaining patient care standards.
US
US hospitals account for the most extensive carbon pollution – approximately 8.5% of the nation’s carbon footprint and here, too, change often comes from the surgeons themselves.
National healthcare accrediting bodies, such as the Joint Commission, often face challenges implementing mandatory emissions reduction measures, leaving voluntary certifications as the primary means for hospitals to address their carbon footprint.
As a result, hospitals like the University of Pittsburgh Medical Centre (UPMC) are taking proactive steps to reduce carbon emissions.
UPMC has pledged to cut carbon emissions by half by 2030, driven by healthcare professionals and climate activists.
Clinicians for Climate Action is a group of healthcare professionals committed to reducing greenhouse gas emissions from healthcare systems in Pennsylvania and beyond.
The group was formed in 2022 when several physicians in Pittsburgh decided to organise their healthcare professional colleagues to call for system-wide changes at their institution to address the climate crisis.
The UPMC Centre for Sustainability is also working to form local groups to head up sustainability efforts at each of our 40 hospitals.
Reusable sensors, decreased cafeteria food waste and the reduction of single-use items are some initiatives hospitals are adopting.
Leslie Davis is the CEO and President at UPMC. She notes: ‘At UPMC, environmental stewardship is another way we can help keep our communities healthy. The healthcare industry accounts for 10% of all US greenhouse gas emissions. While much work is ahead of us, teams here at UPMC are spearheading efforts to make our operations more sustainable. UPMC is charting a course to carbon neutrality to cut our carbon emissions in half by 2030.’
Leslie added: ‘Change often starts from the inside out: in 2022, several of our physicians joined to form Clinicians for Climate Action. Their goal was formidable: reducing greenhouse gas emissions within our organisation. One year later, this group boasts more than 500 members advocating for waste reduction, climate health education, health equity, and other causes.’
Sweden
Sometimes, it takes sources outside of the profession to highlight the need to do better.
Dutch artist Maria Koijck underwent breast cancer surgery in 2021. Stunned by the amount of waste generated by her procedure, including the postoperative care, she created an art installation that asked the healthcare industry a straightforward question: Is there another way?
Swedish company Mölnlycke, which specialises in healthcare solutions, picked up on the story and contacted Maria to share news of their efforts to address this issue with their single-use trays ProcedurePak, designed to significantly reduce plastic waste in surgery rooms.
Together, they created this video in which Maria recreates her artwork, this time as if her DIEP flap surgery had been performed with a Mölnlycke ProcedurePak tray.
The before and after image illustrates the difference.
New Zealand
A new sustainability initiative in New Zealand is the first of its kind to recycle waste plastics from surgical delivery systems used in cataract procedures.
Launched earlier this year, industry experts believe it could create a new global pathway to recycle medical waste.
Dr Ainsley Morris is an ophthalmologist in Christchurch and one of the drivers of the new project.
She believes surgeons increasingly have a role as ‘guardians of the earth’ as well as meet patients’ immediate healthcare needs.
She said: ‘The Hippocratic Oath, which guides the ethical decision-making process of medical professionals, says “first do no harm”. The origins of this are rooted in the mandate to act in the best interests of your patient. However, this definition has been broadened as modern medicine and modern society evolve.
‘Around 41,000 cataract operations are performed annually in New Zealand, each producing various forms of waste and 152kg of CO2e emissions. We are currently trialling a way to sanitise and recycle the medical waste left over from these procedures. We hope the programme can be expanded into other forms of surgery that use single-use plastic consumables.’
Various groups and initiatives within healthcare are spearheading efforts to reduce the carbon footprint, minimise waste and promote sustainability in medical practices.
But as an article published in Stanford Medicine magazine suggested: ‘Greening the operating room requires a delicate balance.
‘Surgeons, anaesthesiologists and their colleagues must maintain patient safety and treatment success, while also scrutinising their time-tested routines for ways to become sustainable.’
It appears that a nuanced approach to a more sustainable surgical environment is the way forward in the bid to nurture healthy patients as well as a healthy planet.
References
https://www.bmj.com/content/383/bmj.p1524
https://www.alleghenyfront.org/upmc-pittsburgh-healthcare-carbon-footprint-climate-change/
https://www.molnlycke.com/news/molnlycke-news/swedish-healthcare-company-teams-up-with-dutch-artist-to-co-create-art-of-hospital-waste/
https://stanmed.stanford.edu/greening-operating-room-sustainability/
