Top

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

01-08-2020 | Climate Change | Continuing Professional Development

Environmentally sustainable perioperative medicine: simple strategies for anesthetic practice

Authors: Maria-Alexandra Petre, MD, FRCPC, Stephan Malherbe, MBChB, FRCPC, MMed

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 8/2020

Abstract

Purpose

This continuing professional development module aims to inform anesthesiologists about the magnitude of healthcare-related waste and its contribution to global warming, as well as providing general strategies to improve environmental sustainability in daily anesthesia practice in a Canadian context.

Principal considerations

Global warming is considered to be the biggest global health threat of the 21^st century. Healthcare is not only adversely impacted by but also a significant contributor to global warming and environmental degradation. Healthcare provision produces 4.6% of the total national greenhouse gas emissions in Canada, while healthcare waste has increased unabated in recent years, largely because of increased use of disposable medical supplies. Operating rooms are highly energy-intensive and produce up to 33% of total hospital waste. Increasingly, attention in healthcare is being focused on environmental sustainability by exploring evidence-based approaches to more sustainable delivery of healthcare. Key to environmental sustainability research is the life-cycle assessment methodology, which measures the cradle-to-grave impact of products on various environmental outcomes and empowers purchasing departments to make environmentally conscious decisions. By using the “reduce, reuse, recycle” hierarchy of waste reduction, several easily implementable evidence-based strategies are proposed to reduce the environmental footprint of everyday anesthesia practice. These recommendations focus on informed decisions on volatile anesthetic use, reduced drug waste, limited use of single-use devices, and meticulous waste segregation and recycling strategies.

Conclusions

Anesthesiologists have a unique opportunity to be champions of environmental sustainability through evidence-based practices, while simultaneously reaping significant synergistic health, cost, and quality co-benefits.

Watts N, Amann M, Ayeb-Karlsson S, et al. The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. Lancet 2018; 392: 581-630.

Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 2009; 373: 1693-733.PubMed

Eckelman MJ, Sherman J. Environmental impacts of the U.S. Health Care System and effects on public health. PLoS One 2016; https://doi.org/10.1371/journal.pone.0157014.

Eckelman MJ, Sherman JD, MacNeill AJ. Life cycle environmental emissions and health damages from the Canadian healthcare system: an economic-environmental-epidemiological analysis. PLoS Med 2018; . https://doi.org/10.1371/journal.pmed.1002623.CrossRefPubMedPubMedCentral

Masson-Delmentte V, Zhai P, Portner HO, et al. IPCC, 2018: Summary For Policymakers. An IPCC Special Report on the impacts of global warming of 1.5°C above pre-industrial levels and related global emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty. Available from URL: https://www.ipcc.ch/site/assets/uploads/sites/2/2019/05/SR15_SPM_version_report_LR.pdf (accessed February 2020).

MacNeill AJ, Lillywhite R, Brown CJ. The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. Lancet Planet Health 2017; 1: e381-8.PubMed

Petre MA, Bahrey L, Levine M, van Rensburg A, Crawford M, Matava C. A national survey on attitudes and barriers on recycling and environmental sustainability efforts among Canadian anesthesiologists: an opportunity for knowledge translation. Can J Anesth 2018; 66: 272-86.PubMed

Thiel CL, Eckelman M, Guido R, et al. Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States. Environ Sci Technol 2015; 49: 1779-86.PubMed

Naylor C, Appleby J. Sustainable health and social care: Connecting environmental and financial performance. The King’s Fund. 2012. Available from URL: https://www.kingsfund.org.uk/publications/sustainable-health-and-social-care (accessed February 2020).

10.

Rebitzer G, Ekvall T, Frischknecht R, et al. Life cycle assessment part 1: framework, goal and scope definition, inventory analysis, and applications. Environ Int 2004; 30: 701-20.PubMed

11.

Pennington DW, Potting J, Finnveden G, et al. Life cycle assessment Part 2: Current impact assessment practice. Environ Int 2004; 30: 721-39.PubMed

12.

Sherman J, Le C, Lamers V, Eckelman M . Life cycle greenhouse gas emissions of anesthetic drugs. Anesth Analg 2012; 114: 1086-90.

13.

Eckelman M, Mosher M, Gonzalez A, Sherman J. Comparative life cycle assessment of disposable and reusable laryngeal mask airways. Anesth Analg 2012; 114: 1067-72.PubMed

14.

Atcheson CL, Spivack J, Williams R, Bryson EO. Preventable drug waste among anesthesia providers: opportunities for efficiency. J Clin Anesth 2016; 30: 24-32.PubMed

15.

Sherman JD, Raibley LA 4th, Eckelman MJ. Life cycle assessment and costing methods for device procurement: comparing reusable and single-use disposable laryngoscopes. Anesth Analg 2018; 127: 434-43.PubMed

16.

McGain F, Naylor C. Environmental sustainability in hospitals - a systematic review and research agenda. J Health Serv Res Policy 2014; 19: 245-52.PubMed

17.

Wernet G, Conradt S, Isenring HP, Jiménez-González C, Hungerbühler K. Life cycle assessment of fine chemical production: a case study of pharmaceutical synthesis. Int J Life Cycle Assess 2010; 15: 294-303.

18.

Johnson SW. Summarizing green practices in U.S. hospitals. Hosp Top 2010; 88: 75-81.

19.

Lewis D, Tranter G, Axford AT. Use of videoconferencing in Wales to reduce carbon dioxide emissions, travel costs and time. J Telemed Telecare 2009; 15: 137-8.PubMed

20.

Masino C, Rubinstein E, Lem L, Purdy B, Rossos PG. The impact of telemedicine on greenhouse gas emissions at an academic health science center in Canada. Telemed J E Health 2010; 16: 973-6.PubMed

21.

Turley M, Porter C, Garrido T, et al. Use of electronic health records can improve the health care industry’s environmental footprint. Health Aff (Millwood) 2011; 30: 938-46.

22.

Cosford P. ‘Partners in clime’: sustainable development and climate change - what can the National Health Service do? Public Health 2009; 123: e1-5.PubMed

23.

Mejia EA, Sattler B. Starting a health care system green team. AORN J 2009; 90: 33-40.PubMed

24.

Ryan-Fogarty Y, O’Regan B, Moles R. Greening healthcare: systematic implementation of environmental programmes in a university teaching hospital. J Clean Prod 2016; 126: 248-59.

25.

Andersen MP, Nielsen OJ, Wallington T, Karpichev B, Sander SP. Assessing the impact on global climate from general anesthetic gases. Anesth Analg 2012; 114: 1081-5.

26.

Ryan SM, Nielsen CJ. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg 2010; 111: 92-8.PubMed

27.

Özelsel TJ, Sondekoppam RV, Ip VH, Tsui BC. Re-defining the 3R’s (reduce, refine, and replace) of sustainability to minimize the environmental impact of inhalational anesthetic agents. Can J Anesth 2019; 66: 249-54.PubMed

28.

Mankes RF. Propofol wastage in anesthesia. Anesth Analg 2012; 114: 1091-2.PubMed

29.

Ip VH, Sondekoppam RV, Özelsel TJ, Tsui B. How I Do It: Edmonton Perspectives in Providing Sustainable Anesthesia. ASRA News 2018 [cited 2019 Nov 11]. Available from URL: https://www.asra.com/asra-news/article/146/how-i-do-it-edmonton-perspectives-in-pro (accessed February 2020).

30.

Özelsel T, Sondekoppam RV, Ip VH, Tsui BC. Coming of age for “green” anesthesia: the leading role of regional anesthesia. Reg Anesth Pain Med 2017; 42: 799-800.PubMed

31.

Alexander R, Poznikoff A, Malherbe S. Greenhouse gases: the choice of volatile anesthetic does matter. Can J Anesth 2018; 65: 221-2.PubMed

32.

Feldman JM. Managing fresh gas flow to reduce environmental contamination. Anesth Analg 2012; 114: 1093-101.PubMed

33.

Sommerfield D, von Ungern-sternberg BS. The mask or the needle? Which induction should we go for? Curr Opin Anaesthesiol 2019; 32: 377-83.PubMed

34.

Doyle DJ, Byrick R, Filipovic D, Cashin F. Silica zeolite scavenging of exhaled isoflurane: a preliminary report. Can J Anesth 2002; 49: 799-804.PubMed

35.

Axelrod D, Bell C, Feldman J, et al. Greening the Operating Room and Perioperative Arena: Environmental Sustainability for Anesthesia Practice. American Society of Anesthesiologists. Available from URL: https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-equipment-and-facilities/environmental-sustainability/greening-the-operating-room (accessed February 2020).

36.

Sherman JD, Barrick B. Total intravenous anesthetic versus inhaled anesthetic: pick your poison. Anesth Analg 2019; 128: 13-5.PubMed

37.

Gillerman RG, Browning RA. Drug use inefficiency: a hidden source of wasted health care dollars. Anesth Analg 2000; 91: 921-4.PubMed

38.

Lejus C, Blanloeil Y, Oudot M, et al. Atropine and ephedrine: a significant waste in the operating theatre. Anaesthesia 2012; 67: 300-1.PubMed

39.

Fortier CR, Abernathy JH, Shepherd M, Guidry OF. Conversion to pre-filled medication syringes reduces medication waste and costs. Anesth Analg 2011; 112: S124 (abstract).

40.

Sherman JD, Hopf HW. Balancing infection control and environmental protection as a matter of patient safety: the case of laryngoscope handles. Anesth Analg 2018; 127: 576-9.PubMed

41.

Overcash M. A comparison of reusable and disposable perioperative textiles: sustainability state-of-the-art 2012. Anesth Analg 2012; 114: 1055-66.PubMed

42.

Vozzola E, Overcash M, Griffing E. Environmental considerations in the selection of isolation gowns: a life cycle assessment of reusable and disposable alternatives. Am J Infect Control 2018; 46: 881-6.PubMed

43.

Kramer A, Kranabetter R, Rathgeber J, et al. Infection prevention during anaesthesia ventilation by the use of breathing system filters (BSF): joint recommendation by German Society of Hospital Hygiene (DGKH) and German Society for Anaesthesiology and Intensive Care (DGAI). GMS Krankenhhyg Interdiszip 2010; . https://doi.org/10.3205/dgkh000156.CrossRefPubMedPubMedCentral

44.

Association of Anaesthetists of Great Britain and Ireland. Infection control in anaesthesia. Anaesthesia 2008; 63: 1027-36.

45.

Dubler S, Zimmermann S, Fischer M, et al. Bacterial and viral contamination of breathing circuits after extended use – an aspect of patient safety? Acta Anaesthesiol Scand 2016; 60: 1251-60.PubMed

46.

McGain F, Algie CM, O’Toole J, et al. The microbiological and sustainability effects of washing anaesthesia breathing circuits less frequently. Anaesthesia 2014; 69: 337-42.PubMed

47.

Grimmond T, Reiner S. Impact on carbon footprint: a life cycle assessment of disposable versus reusable sharps containers in a large US hospital. Waste Manag Res 2012; 30: 639-42.PubMed

48.

McGain F, McAlister S, McGavin A, Story D. A life cycle assessment of reusable and single-use central venous catheter insertion kits. Anesth Analg 2012; 114: 1073-80.PubMed

49.

McGain F, Story D, Lim T, McAlister S. Financial and environmental costs of reusable and single-use anaesthetic equipment. Br J Anaesth 2017; 118: 862-9.PubMed

50.

Polisena J, Hailey D, Moulton K, et al. Reprocessing and reuse of single-use medical devices: a national survey of Canadian acute-care hospitals. Infect Control Hosp Epidemiol 2008; 29: 437-9.PubMed

51.

Unger S, Landis A. Assessing the environmental, human health, and economic impacts of reprocessed medical devices in a Phoenix hospital’s supply chain. J Clean Prod 2016; 112: 1995-2003.

52.

Negri de Sousa AC, Levy CE, Freitas MI. Laryngoscope blades and handles as sources of cross-infection: an integrative review. J Hosp Infect 2013; 83: 269-75.

53.

Rutala WA, Weber DJ. New developments in reprocessing semicritical items. Am J Infect Control 2013; 41(5 Suppl): S60-6.PubMed

54.

Ofstead CL, Quick MR, Wetzler HP, et al. Effectiveness of reprocessing for flexible bronchoscopes and endobronchial ultrasound bronchoscopes. Chest 2018; 154: 1024-34.PubMed

55.

Kagoma Y, Stall N, Rubinstein E, Naudie D. People, planet and profits: the case for greening operating rooms. CMAJ 2012; 184: 1905-11.

56.

McGain FM, Hendel SA, Story DA. An audit of potentially recyclable waste from anaesthetic practice. Anaesth Intensive Care 2009; 37: 820-3.PubMed

57.

Wyssusek KH, Foong WM, Steel C, Gillespie BM. The Gold in garbage: implementing a waste segregation and recycling initiative. AORN J 2016; 103(316): e1-8.

58.

McGain F, White S, Mossenson S, Kayak E, Story D. A Survey of anesthesiologists’ views of operating room recycling. Anesth Analg 2012; 114: 1049-54.PubMed

59.

McGain F, Clark M, Williams T, Wardlaw T. Recycling plastics from the operating suite. Anaesth Intensive Care 2008; 36: 913-4.PubMed

60.

Gaiser RR, Cheek TG, Gutsche BB. Glass recycling in the labour suite is environmetally sound and economical. Br J Anaesth 2004; 92: 584-6.PubMed

61.

Shelton CL, McBain SC, Mortimer F, White SM. A new role for anaesthetists in environmentally-sustainable healthcare. Anaesthesia 2019; 74: 1091-4.PubMed

Title: Environmentally sustainable perioperative medicine: simple strategies for anesthetic practice
Authors: Maria-Alexandra Petre, MD, FRCPC
Stephan Malherbe, MBChB, FRCPC, MMed
Publication date: 01-08-2020
Publisher: Springer International Publishing
Keyword: Climate Change
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 8/2020
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-020-01726-0

At a glance: The STEP trials

Springer Medicine

Environmentally sustainable perioperative medicine: simple strategies for anesthetic practice

Abstract

Purpose

Principal considerations

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Principal considerations

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2020

The lack of construct validity when assessing clinical clerks during their anesthesia rotations

In reply: Ocular ultrasonography in patients with subarachnoid hemorrhage and Terson syndrome

A randomized-controlled trial of sugammadex versus neostigmine: impact on early postoperative strength

Effect of early cognitive interventions on delirium in critically ill patients: a systematic review

Injection pressure monitoring at the needle tip for detection of perineural and nerve-contact position: a cadaver study

Description of a novel oral airway: the McKay airway