Forbes McGain

Environmental sustainability in hospitals – a systematic review and research agenda

Objectives Hospitals are significant contributors to natural resource depletion and environmental change. Our objective was to establish the extent to which hospital environmental sustainability has been studied and the key issues that emerge for policy, practice and research. Methods The PubMed, Engineering Village, Cochrane and Kings Fund databases were searched for articles relating to hospital environmental sustainability published in English between 1 January 1990 and 1 October 2013. Further studies were found by review of reference lists. One hundred ninety-three relevant articles were found and 76 were selected for inclusion in the review. Results Common research themes were identified: hospital design, direct energy consumption, water, procurement, waste, travel and psychology and behaviour. Some countries (particularly the United Kingdom) have begun to invest systematically in understanding the environmental effects of hospitals. We found large variability in the extent of the evidence base according to topic. Research regarding the architectural fabric of hospital buildings is at a relatively mature stage. Similarly, there is a developed research base regarding devices and technologies used within hospitals to reduce the environmental effects of direct hospital energy and water use. Less is known about the clinical, psychological and social factors that influence how health care professionals use resources, travel to/from hospital, and interact with the buildings and technologies available. A significant part of the environmental footprint of hospitals relates to clinical practice, e.g. decisions regarding the use of pharmaceuticals and medical devices. Medical ‘cradle to grave’ life cycle assessment studies have been published to understand the full financial and environmental costs of hospital activities. The effects of preventive or demand management measures which avoid unnecessary hospital procedures are likely to be much greater than incremental changes to how hospital procedures are performed. Conclusions There remain significant gaps in the evidence base on hospital sustainability. Assessments of environmental impacts and natural resource use are beginning to be produced, both at the level of individual hospitals and at the health system level. These are an important start, but in many areas do not yet provide sufficiently detailed information to guide decision-making. There are many areas where the interests of patients and the environment coincide, but others where tensions exist. Rising resource costs and climate change mitigation measures are likely to create an increasing stimulus for research on hospital sustainability. Such research will benefit from inter-disciplinary coordination across research funders and countries.

Workplace sustainability: the "cradle to grave" view of what we do.

“The earth is in the midst of an environmental crisis, driven largely by human activity. In our work and personal lives, we all bear responsibility for this, and for the harm it causes to others.” Sustainable work practices can be maintained well into the future by conserving an ecological balance that avoids depleting natural resources or irreversibly disrupting ecosystems. The importance of health care practices for improving environmental sustainability has been illustrated by audits finding that over 8% of the United States’ total CO2 emissions 2 originates from the health care system and that the English National Health Service (NHS) is responsible for over 3% of England’s total CO2 emissions (Table 1, ref. 1). The transition to sustainability can be guided by life cycle assessment (LCA), a scientific method increasingly used to determine the entire “cradle to grave” environmental and financial effects of processes and products. While some hospital sectors and organizations have made great efforts to improve hospital sustainability practices (Table 1, refs. 2–6), anesthesiologists appear to have had only a limited role in these endeavors to date. The practice of anesthesia, however, has far reaching environmental effects: • during one average working day an individual anesthesiologist, administrating N2O or desflurane can contribute the CO2 equivalent of more than 1,000 km (620 miles) of car driving; • annually worldwide, anesthetic gases are estimated to have the same global warming potential as one million American passenger cars; • every day of the year United States operating room staff will deposit into landfill more than 1,000 tons of rubbish (Table 1, ref. 7), of which anesthetic practice is likely to contribute 1/4 of the total.

A life cycle assessment of reusable and single-use central venous catheter insertion kits.

BACKGROUND: 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. METHODS: 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. RESULTS: Inclusive of labor, the reusable central venous catheter insertion kits cost

The microbiological and sustainability effects of washing anaesthesia breathing circuits less frequently

6.35 Australian (

An audit of intensive care unit recyclable waste

A) (95% confidence interval [CI],

Sustainable hospitals? An Australian perspective.

A5.89 to

Financial and environmental costs of reusable and single-use anaesthetic equipment

A6.86), and the single-use kits cost

Hospital steam sterilizer usage: could we switch off to save electricity and water?

A8.65. For the reusable kit, CO2 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 CO2 emissions: electricity from hospital gas cogeneration resulted in 436 g CO2 (95% CI, 410 to 473 g CO2), from the United States electricity grid 764 g CO2 (95% CI, 509 to 1174 g CO2), and from the European electricity grid 572 g (95% CI, 470 to 713 g CO2). CONCLUSIONS: 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.

The Environmental footprint of morphine: a life cycle assessment from opium poppy farming to the packaged drug

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

Risk management: where are hospital 'green' committees and officers?

AU 5219 (£3079, €3654,