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Financial and environmental costs of reusable and single-use anaesthetic equipment
Abstract
Background.:
An innovative approach to choosing hospital equipment is to consider the environmental costs in addition to other costs and benefits.
Methods.:
We used life cycle assessment to model the environmental and financial costs of different scenarios of replacing reusable anaesthetic equipment with single-use variants. The primary environmental costs were CO 2 emissions (in CO 2 equivalents) and water use (in litres). We compared energy source mixes between Australia, the UK/Europe, and the USA.
Results.:
For an Australian hospital with six operating rooms, the annual financial cost of converting from single-use equipment to reusable anaesthetic equipment would be an AUD30 000 (£18 000) per annum, but increased the CO 2 emissions by almost 10%. The CO 2 offset is highly dependent on the power source mix, while water consumption is greater for reusable equipment.
... Some studies included the temporal aspect of the devices in the FU. For instance, McGain et al. (2017) defined the FU as anaesthetic procedures done in 1 year. Similarly, Lyne et al. (2020) also considered the temporal aspect by defining the FU as individual toothbrush uses over 5 years. ...
... Although the inclusion of the use phase might offer important insights into its overall contribution, it is argued that the resources required to obtain all information necessary for including the use phase are not justifiable in the comparative studies. Also, some studies exclude the use phase, arguing that the contribution of this phase to the environmental impact is very low compared to other life cycle stages (Kemble et al. 2023;McGain et al. 2017). However, consideration of this phase is only done at product level. ...
... Among the 17 selected studies, nine studies conducted sensitivity or uncertainty analysis (Table A.4 in Supplementary Materials). For instance, Baboudjian et al. (2022), Thiel et al. (2015), and McGain et al. (2017 conducted a Monte Carlo analysis to quantify the variability in energy and material consumption, as well as uncertainty in inventory data. In Baboudjian et al. (2022), results presented some uncertainty in inventory data selected. ...
Purpose
There has been a recent proliferation of electronic healthcare devices (EHDs); however, their environmental impacts are not yet fully understood. EHDs have direct environmental impacts attributed to the life cycle stages including raw material extraction, manufacturing, distribution, use, and end-of-life (EOL). In addition to the direct impacts, there are indirect impacts that arise from the use of these devices such as favourable effects on the optimization of healthcare procedures and adverse impacts arising from the additional demand for resources.
Methods
This critical review aimed to gain insight into the state of the art of environmental impact assessments of EHDs, after which challenges were identified and recommendations provided to move towards comprehensive environmental sustainability assessments. The literature review relied on three databases (PubMED, Scopus, and Embase) and specific screening steps, resulting in 17 articles, ten of which applied life cycle assessment.
Results and discussion
This paper identified methodological challenges in the selected studies and lack of consistency in evaluating the environmental impacts of EHDs. For example, seven studies used device-oriented FU, while others applied a treatment-oriented FU, however, all of which aim to investigate the environmental performance of EHDs. These inconsistencies between studies make it hard to understand the environmental sustainability of EHDs. Moreover, the impacts of these devices are mostly considered at the product level and overlook potential indirect impacts associated with the healthcare value delivered by the EHDs (e.g. fewer hospital bed days).
Conclusions
It is important to consider a wider boundary of healthcare pathway rather than the narrow boundary of the device. This will involve considering both the direct life cycle impacts of the device (e.g. impacts related to production or end-of-life) and the positive and negative effects of using the EHDs at the healthcare pathway level. This would result in comprehensive environmental sustainability assessments of EHDs from a healthcare perspective.
... Biofilm-producing organism are said to be associated with nearly 50% of the nosocomial infection [4]. With respect to contamination in anesthesia machine breathing circuits, McGain et al. [5] suggested that reusable external circuits be replaced after seven days, whereas Yang et al. [6] suggested that internal circuits of anesthesia machines be disinfected every seven days when respiratory filters are not used. Spertini et al. [7] found that there was no significant relationship between internal contamination and disinfection intervals in anesthesia machines when using filters between the endotracheal tube and the external breathing circuit, at the outlet and inlet of the anesthesia machine, and the external respiratory circuit was changed daily. ...
... This study observed and analyzed the contamination status of anesthesia machines in PACUs within two weeks post-disinfection. Prior related research primarily focused on anesthesia machines in operating rooms [5][6][7][8]. PACUs serves as the location for postoperative anesthesia recovery and tracheal extubation for the majority of surgical patients throughout the hospital except for those who cannot be safely extubated and need to go to the intensive care unit, making its contamination impact extensive and highlighting the paramount importance of disinfection of anesthesia machines [15]. Consequently, this study selected anesthesia machines in PACUs as the subject of investigation. ...
... Hartmann et al. [8] also found that the bacterial positivity rate of anesthesia machines was lower at 72 h after disinfection than at 48 h, which is similar to the results of this study. Some studies have indicated that the disinfection interval for the breathing circuits in anesthesia machines in specific usage scenarios is 7 days [5,6]. However, based on findings in this study, when a single external circuit and respiratory filter of the anesthesia machine is used for each individual, contamination of PACU did not signifcantly increase within two weeks. ...
Objective
The objective of this study is to investigate bacterial proliferation within the internal circuits of anesthesia machines in post-anesthesia care units (PACUs) following the implementation of the new protocol, where ‘a single dedicated external circuit is used for each individual patient.’ This measure was introduced during the COVID-19 pandemic, in alignment with a novel prevention and control strategy.
Methods
Using the observational technique, we analyzed anesthesia machines in PACUs between July and September 2022. The internal circuits of the anesthesia machines were disinfected every two weeks. Samples were obtained from the internal circuits on the 3rd, 5th, 7th, 10th, 12th, and 14th day following disinfection for bacterial culture. Changes in the positivity rate of bacteria in the internal circuits over time were analyzed using the generalized estimating equation. The anesthesia machines were divided into the positive group (n = 9) and the negative group (n = 41) based on the sampling results on the 14th day after disinfection. Risk factors for positive bacterial culture results in anesthesia machines in PACUs were analyzed using single-factor modified Poisson analysis and multi-factor modified Poisson regression analysis.
Results
The positivity rates of the internal circuits of anesthesia machines in PACUs on the 3rd, 5th, 7th, 10th, 12th, and 14th day following disinfection were 10%, 14%, 12%, 20%, 16%, and 18% respectively. There were no statistically significant differences when the positive rates of the next five time points and the third day were compared (P > 0.05). Risk factors for the contamination in the internal circuits of anesthesia machines was the number of elderly patients and the overall surgical use duration, with the difference was statistically significant (P < 0.025).
Conclusion
Amid the COVID-19 pandemic, characterized by the adoption of new prevention and control protocols, the disinfection interval for internal circuits of anesthesia machines in PACUs may potentially be extended. However, the emphasis of disinfection should still be placed on those anesthesia machines that have been used for a longer cumulative surgical duration and by a higher number of elderly patients over 60 years old. This approach ensures that resources are allocated effectively.
... For example, emissions from medical equipment could be reduced in renewably powered health services by shifting from single-use to reusable instruments. Use of infrastructural changes, such as using large washers for sterilisation purposes, 8 results in economic benefits by reduced procurement costs over the life cycle of single-use equipment 9 and reduced single-use packaging waste. 8,9 Using renewable energy to power large washers can optimise the decontamination process for reusable equipment, potentially offsetting increased resource and energy consumption associated with their frequent treatment. ...
... Use of infrastructural changes, such as using large washers for sterilisation purposes, 8 results in economic benefits by reduced procurement costs over the life cycle of single-use equipment 9 and reduced single-use packaging waste. 8,9 Using renewable energy to power large washers can optimise the decontamination process for reusable equipment, potentially offsetting increased resource and energy consumption associated with their frequent treatment. This was demonstrated by a study revealing a reversal in greenhouse gas emissions impact when using energy mixes from the United Kingdom/European Union or the United States, instead of the assumed coal-based Australian energy mix. ...
... This was demonstrated by a study revealing a reversal in greenhouse gas emissions impact when using energy mixes from the United Kingdom/European Union or the United States, instead of the assumed coal-based Australian energy mix. 8 Chemicals and gases contribute to scope 3 emissions through their procurement, transport and storage. To model the associated emission reduction potential, research is needed regarding renewably powered onsite production of gases such as medical-grade oxygen, and chemicals such as hydrogen peroxide for cleaning purposes. ...
... This is especially important within the anaesthetic speciality which contributes to a significant proportion of healthcare-associated pollution, with large amounts of equipment usage alongside waste anaesthetic gases [21]. Using reusable equipment can have financial benefits, for instance, when the application of reusable anaesthetic equipment compared to single-use was studied at an Australian hospital, there was a 46% decrease in annual financial cost when using reusable equipment [22]. However, in this study, they predicted that in Australia when using reusable equipment there was a higher carbon footprint generated, whereas in the United Kingdom/United States/Europe, the carbon footprint was lower. ...
... This reflects the different infrastructure within the countries and the dependence on different energy sources. Furthermore, cleaning reusable equipment may use more water than is required for manufacturing single-use equipment, therefore, the blanket notion that reusable equipment will be more environmentally friendly cannot necessarily be applied everywhere [22]. Infection control has led to hospitals embracing single-use anaesthetic equipment. ...
Background
The financial burden of running the National Health Service (NHS) is high. Staff members should be aware of the cost of the equipment they use to enable efficient use of resources, reduce waste, and control spending. However, limited financial education at undergraduate and junior stages has contributed to relatively poor knowledge among healthcare workers at all levels. Anaesthetics is a speciality which uses a large amount of equipment; therefore, we aim to assess the cost awareness among staff for commonly used consumables. Furthermore, we aim to assess staff members’ attitudes towards the financial and environmental impact of the equipment they use and whether this would change their practice.
Methodology
An electronic survey was sent to staff members from the anaesthetic department of the Medway NHS Foundation Trust during a one-month period. Respondents were asked to estimate the cost of 19 commonly used anaesthetic consumables, with an estimate categorised as correct if it was within 20% of the actual cost. At the end of the survey, there were five questions for respondents to answer regarding the financial and environmental impact of their current healthcare practice and possible alternatives.
Results
There were 69 respondents within the anaesthetic department from a variety of roles. Overall, only 9.37% of items were estimated correctly, with cheaper items commonly being overestimated and more expensive items being underestimated. Overall, 60% of respondents said the cost of an item would influence their use. The overwhelming majority claimed that the environmental impact was a concern, and most would favour recyclable/reusable alternatives.
Conclusions
Cost awareness among anaesthetic staff for commonly used equipment is poor. More education and training are necessary in this area as limited knowledge of service costs restricts the ability to make cost-efficient choices which are needed in the current NHS.
... Um evidenzbasiert die Entscheidung zwischen medizinischen Einwegund Mehrwegprodukten zu unterstützen, sollten also Lebenszyklusanalysen genutzt werden. Insbesondere mit fortschreitender Energiewende und bei Eigenproduktion von Strom aus erneuerbaren Quellen durch die aufbereitende Stelle ist die Umweltbilanz für Mehrwegprodukte meist besser als für Einwegpro-dukte (McGain et al. 2017;. ...
... Deshalb sollten diese Studien nur mit Vorsicht genutzt werden. Ein Beispiel für diesen Fall ist die Studie von McGain et al. (2017). Dort werden die finanziellen und ökologischen Auswirkungen von Einweg-und Mehrweg-Anästhesieequipment berichtet. ...
Zusammenfassung
Die Gesundheit der Umwelt und der Menschheit sind untrennbar miteinander verknüpft. Klimawandel und Umweltverschmutzungen wirken sich negativ auf Gesundheit aus und der Gesundheitssektor hat die Aufgabe, dies abzufangen. Gleichzeitig hat der Gesundheitssektor selbst diverse Auswirkungen auf die Umwelt. Dazu zählen unter anderem die Freisetzung von Treibhausgasemissionen, Feinstaub und Luftschadstoffen, aber auch reaktiver Stickstoff und Arzneimittelrückstände im Wasser sowie der Verbrauch knappen Wassers. Diese Umweltauswirkungen entstehen einerseits direkt durch die Aktivitäten von Krankenhäusern und anderen Gesundheitseinrichtungen oder durch deren Abfälle. Andererseits entstehen sie indirekt entlang internationaler Lieferketten von z. B. Medizinprodukten und Medikamenten. Während die Wissensbasis zu Treibhausgasemissionen durch den Gesundheitssektor langsam wächst, ist zu anderen Umweltauswirkungen immer noch sehr wenig bekannt. Dieser Beitrag gibt einen Überblick über den aktuellen Wissensstand und diskutiert deren Auswirkungen für die medizinische Versorgung.
... Not all LCAs of single-use versus reusable or reprocessed medical devices and supplies demonstrate an environmental benefit for reprocessing, as some reprocessing efforts can be more resource-intensive and/or environmentally inefficient than the production of the primary product. 8,10,[26][27][28] Similar to our observations, other LCAs also found that reprocessing is the largest impact on the environmental footprint of reprocessed devices whereas manufacturing is most prominent for single-use devices. 5,6,27 There are several benefits of the LCA method for the health sector. ...
... 8,10,[26][27][28] Similar to our observations, other LCAs also found that reprocessing is the largest impact on the environmental footprint of reprocessed devices whereas manufacturing is most prominent for single-use devices. 5,6,27 There are several benefits of the LCA method for the health sector. Firstly, this LCA shows that even with rigorous standards around device cleaning and disinfection in reprocessing and long transport distances, reprocessing has an environmental advantage. ...
Purpose
Healthcare has a large environmental footprint, not least due to the wide use of single-use supplies. Reprocessing of medical devices is a well-established, regulated process, and can reduce its environmental impact. This life cycle assessment (LCA) compares the environmental footprint of a single-use and a reprocessed version of otherwise identical intermittent pneumatic compression (IPC) sleeves.
Materials and Methods
The LCA was performed in accordance with the international standard ISO 14044 using the Environmental Footprint 3.0 (EF) method for the assessment. Data were obtained in cooperation with IPC sleeve manufacturers. Where no primary data were available, ecoinvent database records were used. The functional unit is five hospital treatments applying IPC. The robustness of the results was interrogated in sensitivity analyses of the energy mix, the ethylene oxide emissions during reprocessing, and the transport distances. The impact of waste reduction on hospital disposal costs was calculated.
Results
The environmental footprint of reprocessed IPC sleeves was found to be reduced in all categories compared to single-use devices, leading to a weighted normalized reduction of 43% across all categories. In a breakdown of the LCA results, reprocessed IPC sleeves were found to reduce the carbon footprint by 40%, with the treatment of five patients with single-use IPC sleeves creating 7 kg CO2eq, compared to 4.2 kg CO2eq from reprocessed sleeves. Waste disposal costs were also reduced by 90%.
Conclusion
Reprocessing of IPC sleeves provides an environmental and economic benefit in comparison to single-use devices.
... The environmental and economic costs of regularly using face masks are notable, and only partly abated by reuse. Other efforts have been made to calculate the balance of all benefits and costs in face-mask wearing for disease prevention [62][63][64][65]. ...
... For example, a country's domestic energy system could make it very difficult for health research projects to operate with minimal carbon emissions, but it would be hard to alter or work around such systems for many (but not all) health research actors. Evidence from the healthcare sector shows how important the broader energy system is to minimising emissions(McGain et al., 2017;Pichler et al., 2019). ...
Six planetary boundaries have already been exceeded, including climate change, loss of biodiversity, chemical pollution, and land-system change. The health research sector contributes to the environmental crisis we are facing, though to a lesser extent than healthcare or agriculture sectors. It could take steps to reduce its environmental impact but generally has not done so, even as the planetary emergency worsens. So far, the normative case for why the health research sector should rectify that failure has not been made. This paper argues strong philosophical grounds, derived from theories of health and social justice, exist to support the claim that the sector has a duty to avoid or minimise causing or contributing to ecological harms that threaten human health or worsen health inequity. The paper next develops ideas about the duty’s content, explaining why it should entail more than reducing carbon emissions, and considers what limits might be placed on the duty.
... Another point addressed is the importance of using reusable products. A multitude of medical facilities have shifted to disposable items, as these products pose fewer hygiene concerns and do not require sterilization [37]. Koch and Pecher also showed that this argument is no longer relevant, and that there is no need to worry about hygiene when transitioning from disposable to reusable products. ...
The implementation of low-carbon healthcare practices will be significantly enhanced by the role of anesthesia personnel. While there is a lack of data on the specific measures being implemented by anesthesia departments in Austria, we conducted interviews with six experts in sustainability within anesthesia to address this knowledge gap. These experts provided insights on strategies for reducing the CO2 impact in the operating theatre, the level of interest among anesthetists in sustainability, the role of green teams in hospitals, and future prospects for sustainable anesthesia. While Austria has made progress in reducing the use of Desfluran, waste separation within operating theatres remains a significant issue. Green teams are present in hospitals, but there is a need for the greater inclusion of anesthetists and clinical staff. The topic of sustainability is becoming increasingly important in the field of anesthesia, and the past three years have witnessed a significant push towards reducing CO2 emissions in hospitals across Austria. The experts identified key steps towards achieving sustainable anesthesia, emphasizing the need for an internal motivation to drive meaningful change. This study highlights the numerous measures that have already been implemented in the pursuit of sustainability in anesthesia and the ongoing efforts towards further improvement.
... While single-use patient circuits are uncommon in veterinary medicine, the switch to reusable anesthesia supplies such as corrugated tubing and rebreathing bags has been shown to significantly reduce CO 2 equivalent waste in human healthcare. 16 Injectable drug waste, while not having the global warming impact of inhalants, 17,18 is still waste that has both a cost and an environmental impact of its own. It has been calculated that up to half of all propofol dispensed is wasted or goes unused in human healthcare, 19,20 something that can be minimized by appropriate drug calculations and/ or switching to agents with a longer shelf life, such as the preservative-containing formulations of propofol and alfaxalone. ...
Volatile anesthetic agents are potent greenhouse gases with warming potential hundreds to thousands of times greater than CO 2 . As health systems, both human and veterinary, seek to reduce their environmental impacts, responsible anesthetic stewardship is a topic of great interest. Through an online survey, we explored the levels of awareness, beliefs, interest, needs, and current actions of veterinary anesthesia professionals around the climate impacts of anesthetic care. We found that even within a respondent group with specialized training and experience, there were significant knowledge gaps about anesthesia’s environmental impacts. We also found there is much interest in learning more about climate-friendly anesthesia and broader sustainability initiatives for the veterinary profession. Fortunately, there already exist many ways for the profession to reduce our environmental impact while still providing excellent patient care. In this article, we explore 5 broad categories of action: (1) reducing the overall quantity of anesthetic agent used; (2) choosing lower-impact anesthetics; (3) considering the fate of the anesthetic end product; (4) expanding learning through formal education, experience, and research; and (5) reaching beyond anesthesia to implement a range of sustainability initiatives at veterinary workplaces. Together, we have an opportunity to create a healthier future for our world, our patients, and each other.
... [21] Natural gas is used for 95% of Singapore's energy needs, and the grid emissions factor is favourable for switching to reusable equipment. [22,23] There are hidden costs of disposal, especially in a land-scarce country, and there is a need to change our understanding from a cradle-to-gate to a cradle-to-grave approach. [24] There is a lack of circularity with our medical equipment, with limited remanufacturing and recycling processes by our suppliers. ...
... This highlights two crucial decarbonisation Scope 3 action areas for attention:(i) Sustainable procurement decisions. Currently, most medical products are single-use stock and designed to be disposed of after use, generating a massive amount of waste that is often toxic to human health and the environment(McGain et al. 2017). ...
If the global healthcare sector were a country, it would be the fifth-largest carbon emitter, also producing massive volumes of waste. A revolutionary transition to an environmentally sustainable model of healthcare is required. Decarbonisation efforts are initially focused on transitioning to renewable energy sources and improving energy efficiency in healthcare facilities (Scopes 1 and 2). One of the major challenges is to reduce the carbon intensity of the broader healthcare sector, especially operational and supply chain-related emissions, which represent 71% of the sector's worldwide emissions (Scope 3). This comment briefly describes the connections between the healthcare sector and climate change and describes several high-impact decarbonisation opportunities, focusing on transitioning from current resource and waste-intensive procurement models and highlighting the planetary co-benefits of fostering low-emissions healthcare. To succeed, this transition will require high-level advocacy and policy changes supported by international collaboration at the global level.
... The full-text studies were assessed by two independent reviewers against the abovementioned inclusion criteria, as well as the additional criterion related to environmental impact. Environmental impact included, but was not limited to, greenhouse gases, water use, eutrophication (pharmaceutical and chemical contamination), ecotoxicity, particular matter or air pollution, plastic waste, ozone depletion, ionising radiation, urban and natural land transformation, mineral depletion, fossil fuel depletion and photochemical oxidant formation [22,23]. Reasons for exclusion of studies at the full-text stage were recorded (Fig. 2). ...
Health care is a major contributor to climate change, and critical care is one of the sector’s highest carbon emitters. Health economic evaluations form an important component of critical care and may be useful in identifying economically efficient and environmentally sustainable strategies. The purpose of this scoping review was to synthesise available literature on whether and how environmental impact is considered in health economic evaluations of critical care.
A robust scoping review methodology was used to identify studies reporting on environmental impact in health economic evaluations of critical care. We searched six academic databases to locate health economic evaluations, costing studies and life cycle assessments of critical care from 1993 to present.
Four studies met the review’s inclusion criteria. Of the 278 health economic evaluations of critical care identified, none incorporated environmental impact into their assessments. Most included studies (n = 3/4) were life cycle assessments, and the remaining study was a prospective observational study. Life cycle assessments used a combination of process-based data collection and modelling to incorporate environmental impact into their economic assessments.
Health economic evaluations of critical care have not yet incorporated environmental impact into their assessments, and few life cycle assessments exist that are specific to critical care therapies and treatments. Guidelines and standardisation regarding environmental data collection and reporting in health care are needed to support further research in the field. In the meantime, those planning health economic evaluations should include a process-based life cycle assessment to establish key environmental impacts specific to critical care.
... For instance, in Australia, the carbon footprint of reusable equipment can slightly surpass that of single-use counterparts due to greater water consumption in the cleaning process. 42 This challenges the conventional belief, highlighting the intricate considerations for sustainable choices. We should encourage our government to use cleaner energy sources such as hydroelectric and wind turbines. ...
Global warming and worsening climate change threaten environmental sustainability and exacerbate disease burdens worldwide. Alarmingly, the health care sector emerged as a substantial contributor to this crisis. The operating theatre significantly contributes to hospital waste and greenhouse gas emissions. Anaesthesiologists are morally compelled to combat this crisis, aligning with our oath as physicians of “first, do no harm,” ensuring patient safety extends beyond the operating room by advocating for sustainable practices that safeguard both health and the environment. Understanding the climate change indicators reveals the alarming impact of human actions on escalating greenhouse gas emissions and their dire repercussions, such as global temperature shifts, severe weather events, and heightened natural disasters. Greener solutions and adaptive policymaking are essential to address procurement, greenhouse gas emissions, and waste management challenges in health care settings. Anaesthesiologists should collaborate with surgeons and hospital management to navigate patient-specific issues analysing the environmental impact of hospital visits, investigations, and comorbidities. Efforts toward sustainable healthcare practices in the preoperative setting, such as telemedicine adoption, promoting eco-friendly transportation, and optimising patient health before surgery should be encouraged. Anaesthesiologists should focus on the environmental impact of anaesthesia drugs, medical equipment, and electricity usage on the environment. We should be more responsible and able to justify our practices concerning the ecological implications of inhaled anaesthetic gases, propofol disposal, plastic-based equipment, and energy demands in operating rooms. The emphasis lies on adopting the 6Rs—rethink, refuse, reduce, reuse, recycle, and research—within anaesthesia practices to minimise environmental footprints.
... There have been several LCA studies investigating the carbon footprint of single-use vs. reusable medical items [5][6][7]. These have shown that single-use items have a greater impact from raw material extraction and manufacturing compared to reusables. ...
Mitigating environmental impacts is an urgent challenge supported by (scientific) intensive care societies worldwide. However, making green choices without compromising high-quality care for critically ill patients may be challenging. The current paper describes a three-step approach towards green intensive care units. Starting with the measurement of environmental sustainability, intensive care units can identify hotspots, quantify the environmental impacts of products and procedures, and monitor sustainable progress. Subsequently, a multidisciplinary approach is proposed to improve environmental sustainability, including a collaboration of procurement specialists and healthcare professionals, using co-creation and green teams as efficient grassroots change agents. A context-specific approach for enhancing sustainable healthcare practices is key in order to fit local regulatory requirements and create support of professionals. A final step is to share results and create momentum, including publishing initiatives and participating in online (inter)national networks. Based on the core sustainability principles, this three-step approach towards green ICUs provides a valuable tool to professionals worldwide to facilitate change towards environmentally responsible intensive care units.
Supplementary Information
The online version contains supplementary material available at 10.1186/s13054-025-05316-8.
Background
The healthcare sector contributes significantly to global warming, yet strategies for reducing its impact are not well integrated into health policy. This scoping review aimed to identify the range of effective interventions that can reduce the environmental footprint of healthcare, and to provide an overview of their impact.
Methods
We searched for peer-reviewed articles published in English, French or Swedish between 2010 and September 2024 in Medline and Web of Science, following the Joanna Briggs Institute guidelines and the PRISMA Extension for Scoping Reviews. Publications were selected by two researchers and a documentalist. Data from included studies were extracted and synthesized in tables and described in a narrative synthesis.
Results
We identified seven systematic reviews and 44 original research articles. Most of the effective interventions targeted hospitals and varied from energy saving practices and reducing potent anaesthetic gases to changing care protocols and improving waste management. The measured impact of interventions was context-specific and depended on national energy sources. Only a few studies reported on the impact of structural and strategic changes in healthcare provision, across care settings.
Conclusions
There is an urgent need for better understanding the costs and benefits of diffusing effective green interventions across care providers and developing more systemic approaches for optimising care provision and use, to achieve a meaningful impact.
Abstrac
Purpose
Awareness is growing about the need for a circular healthcare sector. Choosing between single-use (SU) and reusable (RU) medical instruments should be based on evidence-based reasoning. RU and SU instruments differ in many stages of their life cycle. Vaginal specula are commonly used instruments in hospitals and in primary care. The aim of this study was to compare the environmental and economic cost of RU specula and three types of SU specula.
Methods
This study evaluated the environmental sustainability of using RU or SU vaginal specula through a cradle-to-grave life cycle assessment (LCA), using the ReCiPe 2016 Midpoint (H) V1.07 method, including 18 midpoints and the three endpoints human health, ecosystem quality, and resource scarcity. One pelvic examination was the functional unit to compare RU stainless steel specula with SU specula made of (i) fossil-based acrylonitrile butadiene styrene (SU ABS), (ii) bio-based polylactic acid (SU PLA), or (iii) polystyrene blades and a polyethylene bolt sterilised with ethylene oxide (SU EO). Alongside the LCA, an economic evaluation was conducted based on the total cost of ownership (TCO). Scenario analyses were performed for the environmental and economic part of the study.
Results
RU specula scored best for global warming leading to 86% less impact than SU ABS, 78% less than SU PLA specula, and 84% less than SU EO specula in the baseline scenario. RU specula performed better than SU specula from four to seven reuses, depending on the SU type. For the three endpoint estimates, RU specula were most favourable in the baseline scenario. Cost analysis for RU specula resulted in a total cost between € 1.22 and € 1.38 per use and between € 0.75 and € 1.34 per use for SU specula. Labour costs comprised more than half of the overall expenses for RU specula, whereas acquisition cost the main cost driver was for SU specula.
Conclusion
Environmental and economic hotspots of RU and SU specula were identified and can be used in decision-making about using more RU instruments. Raw materials and manufacturing were the key environmental and economic impact factors of SU specula. Packaging production and waste management were the main drivers of the environmental impact of RU specula but had only a minor economic impact on the TCO.
Background
Replacing single‐use operating theatre equipment with reusables might be one strategy for reducing the carbon footprint of operating theatres. However, in Australia, where the energy mix is predominantly fossil‐fuel‐based, the re‐sterilization of reusables may increase the carbon footprint. We analyzed the financial and environmental impacts of introducing reusable operating theatre light handles in two NSW hospitals.
Methods
The effects on cost, waste, and carbon footprint of replacing disposable light handle covers with reusable handles in each hospital were analyzed over 12 months using procurement, waste and sterilization data, and life cycle assessment.
Results
Energy requirement for sterilization of reusable handles, increasing alongside weight of the handle, resulted in higher carbon footprint than using disposable covers. At one hospital, using a heavy handle increased carbon emissions sixfold, while the cost of handle sterilization exceeded the cost of disposable covers, resulting in 11% higher cost per use. At the other hospital, using a lighter handle increased carbon emissions by 40% per use, while sterilization cost was less than the cost of disposable covers, resulting in 14.8% lower cost per use. Scenario modelling indicated that sterilizing handles as part of a hollowware set rather than as individual items would significantly reduce cost and carbon footprint. At both hospitals, associated clinical waste was essentially eliminated.
Conclusion
Judicious replacement of disposable covers with lightweight yet durable reusable handles can reduce costs, but increases carbon footprint in the current Australian energy context. Adopting predominantly renewable energy and more efficient sterilization practice would mitigate this.
Purpose of review
Climate change is the biggest threat to human health and survival in the twenty-first century. Emissions associated with healthcare contribute to climate change and there are many personal and professional actions that can reduce carbon emissions. This review highlights why action is necessary and what anaesthetists and healthcare workers can do.
Recent findings
Encouraging continuing research regarding sustainable anaesthesia and expanding education at all levels to include climate action is key. Professionally, actions include limiting use of single-use equipment, reducing reliance on volatile gas inhalational anaesthesia, and adopting low fresh gas flow techniques. Personal actions such as climate-conscious travelling, spending, and eating are important, especially when shared to create climate positive movements.
Summary
This article shows that, while patient safety and quality of care must remain healthcare's top priority, considering the climate implications of care is part of that duty. Many actions that reduce the carbon impact of care simultaneously improve the quality of care and reduce financial cost. More research into sustainable healthcare is needed. Departments and hospitals and must create environments in which climate conversations are welcomed and can result in positive advancements.
Tracheal intubation is a fundamental facet of airway management, for which the importance of achieving success at the first attempt is well recognized. Failure to do so can lead to significant morbidity and mortality if there is inadequate patient oxygenation by alternate means. The evidence supporting the benefits of a videolaryngoscope in attaining this objective is now overwhelming (in adults). This has led to its increasing recognition in international airway management guidelines and its promotion from an occasional airway rescue tool to the first-choice device during routine airway management. However, usage in clinical practice does not currently reflect the increased worldwide availability that followed the upsurge in videolaryngoscope purchasing during the coronavirus disease 2019 pandemic. There are a number of obstacles to widespread adoption, including lack of adequate training, fears over de-skilling at direct laryngoscopy, equipment and cleaning costs, and concerns over the environmental impact, among others. It is now clear that in order for patients to benefit maximally from the technology and for airway managers to fully appreciate its role in everyday practice, proper training and education are necessary. Recent research evidence has addressed some existing barriers to default usage, and the emergence of techniques such as awake videolaryngoscopy and video-assisted flexible (bronchoscopic) intubation has also increased the scope of clinical application. Future studies will likely further confirm the superiority of videolaryngoscopy over direct laryngoscopy, therefore, it is incumbent upon all airway managers (and their teams) to gain expertise in videolaryngoscopy and to use it routinely in their everyday practice..
Introduction
The healthcare sector is a major contributor to the climate crisis, and operating theatres (OTs) are one of the highest sources of emissions. To inform emissions reduction, this study aimed to (i) compare the outcomes of interventions targeting sustainable behaviours in OTs using the Triple Bottom Line framework, (ii) categorise the intervention strategies using the 5Rs (reduce, recycle, reuse, refuse, and renew) of circular economy, and (iii) examine Intervention Functions (IFs) using the Behaviour Change Wheel (BCW).
Methods
Medline, Embase, PsychInfo, Scopus, and Web of Science databases were searched until June 2023 using the concepts: sustainability and surgery. The review was conducted in line with the Cochrane and Joanna Briggs Institution’s recommendations and was registered on PROSPERO. The results were reported in line with PRISMA, Supplemental Digital Content 1, http://links.lww.com/JS9/D210 (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.
Results
Sixteen reviews encompassing 43 life-cycle analyses, 30 interventions, 5 IFs, and 9 BCW policy categories were included. 28/30 (93%) interventions successfully led to sustainability improvements; however, the environmental outcomes were not suitable for meaningful comparisons due to their using different metrics and dependence on local factors. The ‘reduce’ strategy was the most prolific and commonly achieved through ‘ education’ and/or ‘ environmental restructuring’. However, single-session educational interventions were ineffective. Improving recycling relied on ‘ environmental restructuring’ . More intensive strategies such as ‘reuse’ require multiple intervention functions to achieve, either through a sustainability committee or through an intervention package.
Conclusion
Policymakers must examine interventions within the local context. Comparing the outcomes of different interventions is difficult and could potentially be misleading, highlighting the need for a tool integrating diverse outcomes and contextual factors. ‘Reduce’ strategy guarantees environmental and financial savings, and can be achieved through ‘ Education’ and/or ‘ environmental restructuring’ .
The Australian health care system contributes 7% of the national greenhouse gas emission footprint and generates massive waste streams annually. Operating rooms are a particular hotspot, generating at least 20% of the total hospital waste.
A systematic search of several global academic databases was conducted in mid‐2022 (articles from 1992 to 2022) for peer‐reviewed research relevant to waste management in the operating rooms. We then used thematic analysis to enumerate and characterise the strategies and barriers to sustainable waste management in the operating room.
The waste reduction strategies focused on avoidance of high carbon products; correct waste segregation and reduced overage; reusing, reprocessing, and repurposing devices; and improved recycling. The first barrier identified was a constrained interpretation of the concept of “first do not harm”, ingrained in surgeons’ practices, in prioritising single‐use surgical products. The second barrier was ineffective or insufficient waste education. The third barrier was the immediate cost of implementing waste management compared with the long term realisation of environmental and economic benefits. The last barrier to implementing institutional practice change was the lack of policies and regulations at the local hospital, federal and international levels.
We also evaluated the knowledge gaps in current surgical waste research, including lack of benchmarking data and standardised regulations concerning reusable or reprocessed devices, as well as the methods used to promote pro‐sustainability behavioural change.
Environmental exposures including poor air quality and extreme temperatures are exacerbated by climate change and are associated with adverse cardiovascular outcomes. Concomitantly, the delivery of health care generates substantial atmospheric greenhouse gas (GHG) emissions contributing to the climate crisis. Therefore, cardiac imaging teams must be aware not only of the adverse cardiovascular health effects of climate change, but also the downstream environmental ramifications of cardiovascular imaging. The purpose of this review is to highlight the impact of climate change on cardiovascular health, discuss the environmental impact of cardiovascular imaging, and describe opportunities to improve environmental sustainability of cardiac MRI, cardiac CT, echocardiography, cardiac nuclear imaging, and invasive cardiovascular imaging. Overarching strategies to improve environmental sustainability in cardiovascular imaging include prioritizing imaging tests with lower GHG emissions when more than one test is appropriate, reducing low-value imaging, and turning equipment off when not in use. Modality-specific opportunities include focused MRI protocols and low-field-strength applications, iodine contrast media recycling programs in cardiac CT, judicious use of US-enhancing agents in echocardiography, improved radiopharmaceutical procurement and waste management in nuclear cardiology, and use of reusable supplies in interventional suites. Finally, future directions and research are highlighted, including life cycle assessments over the lifespan of cardiac imaging equipment and the impact of artificial intelligence tools. Keywords: Heart, Safety, Sustainability, Cardiovascular Imaging Supplemental material is available for this article. © RSNA, 2024.
Introduction
Orthopaedic surgery is culpable, in part, for the excessive carbon emissions in health care partly due to the utilization of disposable instrumentation in most procedures, such as rotator cuff repair (RCR). To address growing concerns about hospital waste, some have considered replacing disposable instrumentation with reusable instrumentation. The purpose of this study was to estimate the cost and carbon footprint of waste disposal of RCR kits that use disposable instrumentation compared with reusable instrumentation.
Methods
The mass of the necessary materials and their packaging to complete a four-anchor RCR from four medical device companies that use disposable instrumentation and one that uses reusable instrumentation were recorded. Using the cost of medical waste disposal at our institution (0.14 less than the disposable instrumentation systems. The estimated contribution to the overall carbon footprint produced from the disposal of a RCR kit that uses reusable instrumentation was on average 0.37 kg CO2e less than the disposable instrumentation systems.
Conclusion
According to our analysis, reusable instrumentation in four-anchor RCR leads to decreased waste and waste disposal costs and lower carbon emissions from waste disposal. Additional research should be done to assess the net benefit reusable systems may have on hospitals and the effect this may have on a long-term decrease in carbon footprint.
Level of evidence
Level II
The effectiveness of climate-smart approaches is of significant concern because theatres contribute up to 33% of the hospital carbon footprint and 42% of revenue. Despite overwhelming advancements in climate-smart green theatre research, benchmarking remains a challenge. A single index representing their improvements has significant potential to increase control over and to promote their approaches. That is, this study does not stop at an inquiry about climate-smart approaches but also moves a step further and explores a possible outcome measure for the evolution of magnitudes, particularly in favour of the green theatre index (GTI). A function (clinical_theatre_emissions) was created in the R package Carbonr to calculate carbon emission. A time series emission data by theatre were consolidated as GTI using Fisher ideal index. The GTI proves a feasible and accurate consolidated outcome measure for carbon emissions to track and benchmark climate-smart strategies and could be applied in the real-world settings.
Background
Climate change may well be the “largest threat” to humankind. Changes to our climate system lead to a decrease in global health. The healthcare sector presents one of the largest carbon footprints across all industries. Since surgical departments have one of the largest carbon footprints within the healthcare sector, they represent an area with vast opportunities for improvement. To drive change, it is vital to create awareness of these issues and encourage engagement in changes among people working in the healthcare industry.
Methods
We conducted an anonymous cross-sectional survey study to assess awareness among surgeons regarding the impact of healthcare systems on climate change. The questions were designed to investigate surgeons' willingness to accept and promote changes to reduce carbon footprints. Participants included surgical professionals of all ages and levels of expertise.
Results
A total of 210 participants completed the survey in full and were included in the evaluation. Sixty percent emphasized a lack of information and the need for personal education. Over 90 % expressed concern for the environment and a strong desire to gain new insights. Provided that clinical performance remains the same, more than 70 % are willing to embrace carbon-friendly alternatives. In this context, all participants accepted the additional time required for training and initially increased personal efforts to achieve equal performance.
Conclusion
Limited awareness and information about carbon footprints were observed in surgical departments in German hospitals. Nevertheless, the vast majority of surgeons across all age groups are more than willing to acquire new insights and adapt to changes in order to reduce energy consumption and carbon dioxide production.
BACKGROUND
Operating room (OR) expenditures and waste generation are a priority, with several professional societies recommending the use of reprocessed or reusable equipment where feasible. The aim of this analysis was to compare single-use pulse oximetry sensor stickers (“single-use stickers”) versus reusable pulse oximetry sensor clips (“reusable clips”) in terms of annual cost savings and waste generation across all ORs nationally.
METHODS
This study did not involve patient data or research on human subjects. As such, it did not meet the requirements for institutional review board approval. An economic model was used to compare the relative costs and waste generation from using single-use stickers versus reusable clips. This model took into account: (1) the relative prices of single-use stickers and reusable clips, (2) the number of surgeries and ORs nationwide, (3) the workload burden of cleaning the reusable clips, and (4) the costs of capital for single-use stickers and reusable clips. In addition, we also estimated differences in waste production based on the raw weight plus unit packaging of single-use stickers and reusable clips that would be disposed of over the course of the year, without any recycling interventions. Estimated savings were rounded to the nearest 510.5 million (conservative state) to 618k versus a cost savings of 541k (low-interest rates of 2.85%) and $1.3 million (high-interest rates of 7.08%). The annual waste that could be diverted from landfill by transitioning to reusable clips was found to be between 587 tons (conservative state) up to 589 tons (favorable state). If institutions need to purchase new vendor monitors or cables to make the transition, that may increase the 1-time capital disbursement.
CONCLUSIONS
Using reusable clips versus single-use stickers across all ORs nationally would result in appreciable annual cost savings and waste generation reduction impact. As both single-use stickers and reusable clips are equally accurate and reliable, this cost and waste savings could be instituted without a compromise in clinical care.
Purpose of Review
This review illustrates how anesthesia contributes to the carbon footprint. It gives practical reasons why anesthesiologists must understand and participate in sustainable anesthesia.
Recent Findings
Climate change, with the increasing frequency of natural disasters that have negatively impacted health, has received increasing attention within healthcare systems and anesthesia practices. Education on how to green the operating room (reduce, recycle, reuse, rethink, research) is imperative for all anesthesiologists in order for them to implement these actions. The benefit of single-use disposable equipment such as laryngoscopes needs to be assessed thoroughly using life cycle methodology.
Summary
Climate change is a global problem. Anesthesia contributes significantly to greenhouse emissions. Anesthesiologists must be educated on ways to mitigate this contribution and need tools that they can use to start reducing carbon emissions.
The healthcare sector is a driver of economic growth in the US, with spending on healthcare in 2012 reaching $2.8 trillion or 17% of the US gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunity for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the US, the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices; energy used for heating, ventilation, and air conditioning; and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system.
Introduction This paper provides an overview on the content of the ecoinvent database and of selected metholodogical issues applied on the life cycle inventories implemented in the ecoinvent database. Goal, Scope and Background In the year 2000, several Swiss Federal Offices and research institutes of the ETH domain agreed to a joint effort to harmonise and update life cycle inventory (LCI) data for its use in life cycle assessment (LCA). With the ecoinvent data-base and its actual data v1.1, a consistent set of more than 2’500 product and service LCIs is now available. Method Nearly all process datasets are transparently documented on the level of unit process inputs and outputs. Methodological approaches have been applied consistently throughout the entire database content and thus guarantee for a coherent set of LCI data. This is particularly true for market and trade modelling (see, for example, electricity modelling), for the treatment of multi-out-put and of recycling processes, but also for the recording and reporting of elementary flows. The differentiation of diameter size for particulate matter emissions, for instance, allows for a more comprehensive impact assessment of human health effects. Data quality is quantitatively reported in terms of standard deviations of the amounts of input and output flows. In many cases qualitative indicators are reported additionally on the level of each individual input and output. The information sources used vary from extensive statistical works to individual (point) measurements or assumptions derived from process descriptions. However, all datasets passed the same quality control procedure and all information relevant and necessary to judge the suitability of a dataset in a certain context are provided in the database. Data documentation and exchange is based on the EcoSpold data format, which complies with the technical specification ISO/TS 14048. Free access to process information via the Internet helps the user to judge the appropriateness of a dataset.Concluding Remarks The existence of the ecoinvent database proves that it is possible and feasible to build up a large interlinked system of LCI unit processes. The project work proved to be demanding in terms of co-ordination efforts required and consent identification. One main characteristic of the database is its transparency in reporting to enable individual assessment of data appropriateness and to support the plurality in methodological approaches.Outlook Further work on the ecoinvent database may comprise work on the database content (new or more detailed data-sets covering existing or new economic sectors), LCI (modelling) methodology, the structure and features of the data-base system (e.g. extension of Monte Carlo simulation to the impact assessment phase) or improvements in eco-invent data supply and data query. Furthermore, the deepening and building up of international co-operations in LCI data collection and supply is in the focus of future activities.
Growing awareness of the negative impacts from the practice of health care on the environment and public health calls for the routine inclusion of life cycle criteria into the decision-making process of device selection. Here we present a life cycle assessment of 2 laryngeal mask airways (LMAs), a one-time-use disposable Unique™ LMA and a 40-time-use reusable Classic™ LMA.
In life cycle assessment, the basis of comparison is called the "functional unit." For this report, the functional unit of the disposable and reusable LMAs was taken to be maintenance of airway patency by 40 disposable LMAs or 40 uses of 1 reusable LMA. This was a cradle-to-grave study that included inputs and outputs for the manufacture, transport, use, and waste phases of the LMAs. The environmental impacts of the 2 LMAs were estimated using SimaPro life cycle assessment software and the Building for Environmental and Economic Sustainability impact assessment method. Sensitivity and simple life cycle cost analyses were conducted to aid in interpretation of the results.
The reusable LMA was found to have a more favorable environmental profile than the disposable LMA as used at Yale New Haven Hospital. The most important sources of impacts for the disposable LMA were the production of polymers, packaging, and waste management, whereas for the reusable LMA, washing and sterilization dominated for most impact categories.
The differences in environmental impacts between these devices strongly favor reusable devices. These benefits must be weighed against concerns regarding transmission of infection. Health care facilities can decrease their environmental impacts by using reusable LMAs, to a lesser extent by selecting disposable LMA models that are not made of certain plastics, and by ordering in bulk from local distributors. Certain practices would further reduce the environmental impacts of reusable LMAs, such as increasing the number of devices autoclaved in a single cycle to 10 (-25% GHG emissions) and improving the energy efficiency of the autoclaving machines by 10% (-8% GHG emissions). For both environmental and cost considerations, management and operating procedures should be put in place to ensure that reusable LMAs are not discarded prematurely.
Anesthesiologists must consider the entire life cycle of drugs in order to include environmental impacts into clinical decisions. In the present study we used life cycle assessment to examine the climate change impacts of 5 anesthetic drugs: sevoflurane, desflurane, isoflurane, nitrous oxide, and propofol.
A full cradle-to-grave approach was used, encompassing resource extraction, drug manufacturing, transport to health care facilities, drug delivery to the patient, and disposal or emission to the environment. At each stage of the life cycle, energy, material inputs, and emissions were considered, as well as use-specific impacts of each drug. The 4 inhalation anesthetics are greenhouse gases (GHGs), and so life cycle GHG emissions include waste anesthetic gases vented to the atmosphere and emissions (largely carbon dioxide) that arise from other life cycle stages.
Desflurane accounts for the largest life cycle GHG impact among the anesthetic drugs considered here: 15 times that of isoflurane and 20 times that of sevoflurane on a per MAC-hour basis when administered in an O(2)/air admixture. GHG emissions increase significantly for all drugs when administered in an N(2)O/O(2) admixture. For all of the inhalation anesthetics, GHG impacts are dominated by uncontrolled emissions of waste anesthetic gases. GHG impacts of propofol are comparatively quite small, nearly 4 orders of magnitude lower than those of desflurane or nitrous oxide. Unlike the inhaled drugs, the GHG impacts of propofol primarily stem from the electricity required for the syringe pump and not from drug production or direct release to the environment.
Our results reiterate previous published data on the GHG effects of these inhaled drugs, while providing a life cycle context. There are several practical environmental impact mitigation strategies. Desflurane and nitrous oxide should be restricted to cases where they may reduce morbidity and mortality over alternative drugs. Clinicians should avoid unnecessarily high fresh gas flow rates for all inhaled drugs. There are waste anesthetic gas capturing systems, and even in advance of reprocessed gas applications, strong consideration should be given to their use. From our results it appears likely that techniques other than inhalation anesthetics, such as total i.v. anesthesia, neuraxial, or peripheral nerve blocks, would be least harmful to the environment.
For most items used in operating rooms, it is unclear whether reusable items are environmentally and financially advantageous in comparison with single-use variants. We examined the life cycles of reusable and single-use central venous catheter kits used to aid the insertion of single-use, central venous catheters in operating rooms. We did not examine the actual disposable catheter sets themselves. We assessed the entire financial and environmental costs for the kits, including the influence of the energy source used for sterilization.
For the reusable central venous catheter kit, we performed a "time-in-motion" study to determine the labor costs and measured the energy and water consumption for cleaning and sterilization at Western Health, Melbourne, Australia. For the majority of the inputs for the single-use kit, we relied upon industry and inventory-sourced databases. We modeled the life cycles of the reusable and single-use central venous catheter kits with Monte Carlo analysis.
Inclusive of labor, the reusable central venous catheter insertion kits cost A) (95% confidence interval [CI], A6.86), and the single-use kits cost $A8.65. For the reusable kit, CO(2) emissions were 1211 g (95% CI, 1099 to 1323 g) and for the single-use kit 407 g (95% CI, 379 to 442 g). Water use was 27.7 L (95% CI, 27.0 to 28.6 l) for the reusable kit and 2.5 L (95% CI, 2.1 to 2.9 l) for the single-use kit. For the reusable kit, sterilization had the greatest environmental cost, and for the single-use kit, the manufacture of plastic and metal components had the largest environmental costs. Different sources of electricity to make the reusable kits patient-ready again affected the CO(2) emissions: electricity from hospital gas cogeneration resulted in 436 g CO(2) (95% CI, 410 to 473 g CO(2)), from the United States electricity grid 764 g CO(2) (95% CI, 509 to 1174 g CO(2)), and from the European electricity grid 572 g (95% CI, 470 to 713 g CO(2)).
Inclusive of labor, the reusable central venous catheter insertion kits were less expensive than were the single-use kits. For our hospital, which uses brown coal-sourced electricity, the environmental costs of the reusable kit were considerably greater than those of the single-use kit. Efforts to reduce the environmental footprint of reusable items should be directed towards decreasing the water and energy consumed in cleaning and sterilization. The source of hospital electricity significantly alters the relative environmental effects of reusable items.
We modelled the financial and environmental costs of two commonly used anaesthetic plastic drug trays. We proposed that, compared with single-use trays, reusable trays are less expensive, consume less water and produce less carbon dioxide, and that routinely adding cotton and paper increases financial and environmental costs. We used life cycle assessment to model the financial and environmental costs of reusable and single-use trays. From our life cycle assessment modelling, the reusable tray cost (Australian dollars) 0.21 to 0.47 (price range of 0.52) and the single-use tray with cotton and gauze added was $0.90 (no price range in Melbourne). Production of CO2 was 110 g CO2 (95% CI 98 to 122 g CO2) for the reusable tray, 126 g (95% CI 104 to 151 g) for single-use trays alone (mean difference of 16 g, 95% CI -8 to 40 g) and 204 g CO2 (95% CI 166 to 268 g CO2) for the single-use trays with cotton and paper Water use was 3.1 l (95% CI 2.5 to 3.7 l) for the reusable tray, 10.4 l (95% CI 8.2 to 12.7 l) for the single-use tray and 26.7 l (95% CI 20.5 to 35.4 l) for the single-use tray with cotton and paper Compared with reusable plastic trays, single-use trays alone cost twice as much, produced 15% more CO2 and consumed three times the amount of water Packaging cotton gauze and paper with single-use trays markedly increased the financial, energy and water costs. On both financial and environmental grounds it appears difficult to justify the use of single-use drug trays.
In the presence of single-use airway filters, we quantified anaesthetic circuit aerobic microbial contamination rates when changed every 24 h, 48 h and 7 days. Microbiological samples were taken from the interior of 305 anaesthetic breathing circuits over a 15-month period (3197 operations). There was no significant difference in the proportion of contaminated circuits when changed every 24 h (57/105 (54%, 95% CI 45-64%)) compared with 48 h (43/100 (43%, 95% CI 33-53%, p = 0.12)) and up to 7 days (46/100 (46%, 95% CI 36-56%, p = 0.26)). Median bacterial counts were not increased at 48 h or 7 days provided circuits were routinely emptied of condensate. Annual savings for one hospital (six operating theatres) were US 4846) and a 57% decrease in anaesthesia circuit steriliser loads associated with a yearly saving of 2760 kWh of electricity and 48 000 l of water. Our findings suggest that extended circuit use from 24 h up to 7 days does not significantly increase bacterial contamination, and is associated with labour, energy, water and financial savings.
The data quality matrix for product life cycle inventory data proposed inWhdkma &Wlsnaus (J. Cleaner Prod. (1996), 4: 167-174) was subjected to a multi-user test, in which 7 persons scored the same 10 datasets
representing 10 different processes. Deviations among scores were listed, and the causes for deviations were determined and
grouped into a limited number of well-defined classes. For the majority of the scores, the different test persons arrived
at the same score. Deviations occur most often among neighbouring scores. Only a smaller number of the deviations (less than
10% of all scores) affect the overall assessment of the data quality and/or uncertainty of the corresponding dataset. Based
on the analysis of the causes of the deviations, improvements to the matrix and its accompanying explanations were suggested
and implemented (reported in the appendix to this paper). The average time consumption for the scoring by the different test
persons was less than 10 minutes per data set. It is concluded that the time consumption and the number of deviating scores
can be kept at an acceptable level for the pedigree matrix to be recommended for internal data quality management and for
comprehensive communication of quality assessments of large amounts of data.
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DOI: http://dx.doi.org/10.1065/lca2006.04.019
Background
Life cycle assessments have been performed using different methods before the name was coined since about 1970 in several countries of North America and Europe. It was the merit of SETAC to start a standardization process which culminated in the LCA-guidelines ('A code of practice') in 1993. It is the aim of this paper to trace back this and further LCA-related achievements by SETAC on the basis of documents and personal memories. It may be subjective in the selection and weighting of some events, but objectivity is strived for with regard to the whole and, in my view, singular development.
Results and Discussion
Starting 1990 with two workshops in Smuggler's Notch (Vermont) and Leuven (Belgium), SETAC and SETAC Europe organized several workshops during which important topics (framework, impact assessment, data quality, etc.) were treated and published in the form of reports which are still available. The main contribution by CML and its head, Helias Udo de Haes, was a practical method of impact assessment, transforming the formerly more technocratic LCA (energy, resources, waste) into an instrument of environmental assessment of product systems. In addition, important contributions to the allocation problem were made. Starting in 1993, ISO took over the leadership in standardization and SETAC started the famous working groups in North America and Europe, often dealing with the same topics in parallel. Due to the different cultures, the results were frequently complimentary rather than harmonic. The CML-method of LCIA, widely accepted in Europe, had to wait for about 10 years to be accepted at the other side of the Atlantic. It was helpful that SETAC – meanwhile a global organization – looked for a partner in order to implement LCA all over the world. This partner was found in the 'United Nations Environmental Programme' (UNEP) and the UNEP/SETAC Life Cycle Initiative was officially launched by Klaus Töpfer in Prague in April 2002. SETAC also assumed an important role in communicating LCA via publications: workshop and conference reports, the 'code of practice', working group results and LCA News Letters. The annual meetings offered forums for LCA scientists, practitioners and users, well prepared by the LCA Steering Committee (SETAC Europe) and the LCA Advisory Group (SETAC North America).
Recommendation
. The main recommendation to SETAC is to adhere to LCA as the main environmental assessment tool for products and to expand it to a true sustainability assessment tool by adding Life Cycle Costing (LCC) and a still to be invented 'Social Life Cycle Assessment'. SETAC is to remain the scientific arm within the UNEP/SETAC LC Initiative, without loosing its identity. Working groups should be global rather than regional in the future, as suggested by the SETAC Europe LCA Steering Committee at the 2004 World Congress in Portland, Oregon.
This study introduces life cycle assessment as a tool to analyze one aspect of sustainability in healthcare: the birth of a baby. The process life cycle assessment case study presented evaluates two common procedures in a hospital, a cesarean section and a vaginal birth. This case study was conducted at Magee-Womens Hospital of the University of Pittsburgh Medical Center, which delivers over 10,000 infants per year. The results show that heating, ventilation, and air conditioning (HVAC), waste disposal, and the production of the disposable custom packs comprise a large percentage of the environmental impacts. Applying the life cycle assessment tool to medical procedures allows hospital decision makers to target and guide efforts to reduce the environmental impacts of healthcare procedures.
Health care is one of the largest contributors to waste production in the United States. Given increased awareness of the environmental and financial costs associated with waste disposal and its public health impact, many hospitals are adopting environmentally friendly practices that reduce waste production and offer equally effective, yet less expensive alternatives. Reprocessing of medical equipment is one such practice that has gained popularity in recent years and has led to major cost savings across several medical disciplines. In this commentary, we seek to take a closer look at the practice of reprocessing, explore the evidence surrounding its safety, and suggest implications of reprocessing for medical centers.
University of Edinburgh
- Thomson
Steam sterilisation's energy and water footprint
- McGain
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