Waste not, why not? From anesthetic gases to circular-use resource, hospitals need to green up their acts

The people and systems that look after the health of Canadians need to also take a bigger role in taking care of the planet. That was the key message of a position paper issued recently by Ontario’s Anesthesiologists, a sub-section of the Ontario Medical Association that represents the province’s nearly 1,500 practising anesthesiologists. “The Canadian healthcare industry is responsible for producing approximately 5% of our country’s greenhouse gas emissions, in addition to generating other pollutants affecting the air, water and soil,” wrote the group. “Physicians are called upon to act as health advocates and to positively influence the determinants of health.” Dr. David Ohrling, the paper’s lead author and chief of the anesthesiology department at Collingwood General and Marine Hospital in Collingwood, Ont., spoke at a recent OMA media briefing about the healthcare industry’s impact on the environment—it’s a worse offender than the airline industry—and why hospital systems need to apply circular economy principles to procuring and using operating room medical devices and supplies. Read: More than Lyme disease: Be aware of increased risk of tick-borne diseases with climate change Moving away from single-use, disposable products would be a significant step in the right direction. "This is not new thinking, but it's become imperative in the face of a growing climate crisis,” said Dr. Ohrling. “The stuff we use accounts for the majority of healthcare's greenhouse gas emissions—about two-thirds by most estimations. Operating rooms themselves are very resource intensive and generate 20% to 33% of the hospital's total waste.” Much of this waste comes from plastic products discarded after their intended single-use and, in some cases, unused products put out for disposal because they've been unwrapped. In addition to environmental damage from waste, these products also contribute to carbon emissions when they’re manufactured and shipped, added Dr. Ohrling. Just how much waste do hospitals produce? At Collingwood General and Marine Hospital—a relatively small hospital with only 84 beds—23 tonnes of material end up as waste each month. Read: The green way: Meet the doctors of CAPE “There’s almost 400 hospitals in the province,” said Dr. Ohrling. “All of this waste has an environmental impact in producing it, using it, shipping it and disposing of it. This practice really needs to change.” One way to make this change is by moving towards the “circular use of resources where devices and supplies are designed for your reuse,” he added. “They're maintained in a high-quality state for as long as possible and then they're refurbished or recycled, minimizing costs.” There are a growing number of case studies that demonstrate the benefits of re-using devices and supplies in hospitals. As examples of specific products, Dr. Ohrling pointed to reusable laryngeal mask airways and surgical gowns. “In both cases the environmental and financial costs have been shown to be lower with reusables and yet most hospitals are still using single-use disposable products,” he said. Read: Avoid walking or biking down busy streets: Traffic fumes may affect brain connectivity, new Canadian study shows Hospitals also need to look for ways to lower the carbon footprint from anesthetic gases. Desflurane, one of the anesthetic gases used routinely in many hospitals, is known to have a higher global warming potential than other gases—an American Society of Anesthesiologists report pegged it at 40 to 50 times higher over a hundred-year period compared to gases such as sevoflurane and isoflurane—and comes with a higher price tag. A number of Ontario hospitals—including Collingwood—have removed desflurane from their drug formularies, and some have started to look at the environmental impact of other anesthetic and sedative gases. “Nitrous oxide is another potent greenhouse gas and anesthetic gas that our working group has been discussing recently,” said Dr. Ohrling. “The main concerns with nitrous oxide are leakage from supply systems and its persistence in the environment—it will last in the atmosphere for more than 100 years.” Healthcare systems and the doctors who work in them need to start looking at a bigger picture that takes into account the environmental cost of delivering care, he added. “We are in the business of improving people's health and we shouldn't be worsening people's health by worsening the climate crisis,” said Dr. Ohrling. “I think that's the point that needs to be driven home. Our numbers may seem small, but our role is big and our role as leaders is even bigger—we need to lead by example.” Read: Time to ditch your gas stove for health reasons? The answer is ‘murky,’ experts say

Waste not, why not? From anesthetic gases to circular-use resource, hospitals need to green up their acts

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